A new specialty pharmacy program by digital health company Waltz Health has been created to lower costs for payers and provide better experiences for patients and pharmacies.
Waltz Health announced Waltz Connect, a platform that focuses exclusively on specialty drugs.
These drugs treat complex diseases and are usually much more expensive. They are also a growing source of rising drug costs, accounting for less than 5% of the country’s 7 billion prescriptions filled each year but driving 54% of the cost, Waltz Health President Jeff Park told Fierce Healthcare.
“It’s where most of the drug manufacturers are putting their energy and effort,” he said.
The Waltz Connect platform uses its AI engine to route drugs to the best pharmacy based on price, location, turnaround time, adherence rates and fulfillment accuracy. Its technology is similar to its Marketplace Search tool that is available for Medicare Advantage plans.
This engine allows insurers to pay less expensive claims on average.
Waltz is also teaming up with Reliance Rx, a pharmacy focused entirely on specialty drugs. Park said it is one of 80 different dispensing locations in Waltz’ network, giving payers new options and more flexibility.
“Classically in the industry your health plan has one specialty pharmacy, despite the fact there’s a magnitude of opportunities in the marketplace,” Park explained.
Waltz Health supports 9 million patients and will track more than 80 million prescriptions this year. The company works with large insurers like UnitedHealthcare and Humana and alternative players like Mark Cuban’s Cost Plus Drug Company.
Park said large plans can expect to save 10% to 15% on specialty spend with Waltz Connect.’
In September, Waltz CEO and co-founder Mark Thierer told Fierce Healthcare that the company, comprised of former OptumRx executives, aims to become a full-scale pharmacy benefit manager. Its business is a “new model” that operates more effectively than the traditional giants in the space, said Park.
“The old models don’t work,” he said. “They need to be revised and changed. The current models are complicated. They’re hidden behind rebates, fees, firewalls and corporate structures. It’s hard to see what the actual costs really are.”