CerpassRx, Waltz team on AI platform to manage specialty drug spend

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Independent pharmacy benefit manager CerpassRx is looking to better manage specialty drug spend by teaming up with Waltz Health on an artificial intelligence-powered platform called Intelligent Specialty Engine.

The idea is that the approach, which includes real-time analytics and specialty spend management capabilities, will improve transparency and smooth the specialty drug experience for health plans and employers.

Data from the Assistant Secretary for Planning and Evaluation published in 2022 showed specialty drugs account for more than half of total drug spend. Health plans and self-insured employers are facing increasing pressure to manage these expenses more effectively, and in some cases are turning to PBMs.

WHAT'S THE IMPACT?

According to CarepassRx, the new platform – described as a "unique" deployment of Waltz's Connect technology – gives more flexibility and optimizes savings with a network of national and regional specialty pharmacies that compete on price and clinical outcomes. The AI-driven marketplace routes specialty prescriptions to the most cost-effective and clinically appropriate pharmacies.

It also comes with deep data analytics that provide real-time insights into cost savings, said CarepassRx, adding that it also streamlines the prescription process.

"This collaboration with Waltz Health helps to power our already unique specialty management capabilities to a new level," said CerpassRx president Eric Yonkus.

Waltz Connect debuted earlier this year, and was designed to manage all aspects of a payer's specialty medication coverage. It includes proprietary technology, patient engagement support, and a dynamic marketplace with a network of specialty pharmacies that compete on price, service levels and clinical outcomes, the company said.

The goal of Waltz Connect is to achieve transparency by unlocking competition among specialty pharmacies; it's engineered to reduce specialty costs, improve member experience and deliver better member health outcomes.

Calling the design "flexible," Waltz said it allows payers to deploy the solution across their entire specialty-drug formulary, on specific drug classes or even down to individual drugs.

THE LARGER TREND

Waltz Health entered into the Medicare Advantage arena in February, offering health plans that support Medicare beneficiaries' customizable configurations of its proprietary Marketplace Search technology, which lowers prescription drug prices for members while also providing health plans with insight into adherence trends.

Marketplace Search is a white-labeled digital search engine that applies AI to a curated mix of discounted drug pricing sources to help healthcare organizations – including health plans, PBMs, pharmacies and self-insured employers – save their populations money when filling prescriptions.

For plans that support Medicare beneficiaries, the use cases for Marketplace Search can vary depending on their needs. According to Waltz, it gives health plans a tool to assist members in finding savings on covered medications during a coverage gap, finding lower-cost, cash-pay solutions for medication not covered by their plan, and finding patient-assistance programs available to the Medicare population.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.