Waltz Health turns focus to specialty medication coverage
The goal of Waltz Connect is to achieve transparency by unlocking competition among specialty pharmacies.
Photo: RUNSTUDIO/Getty Images
Waltz Health, a digital health company focused on prescription care, has rolled out Waltz Connect, a new end-to-end offering that manages 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 software is built on Waltz Health's Intelligent Specialty Engine, which is an artificial intelligence-enabled prescription routing software that finds the best and most appropriate specialty pharmacy option based on specific criteria selected by each payer.
WHAT'S THE IMPACT
According to the Assistant Secretary for Planning and Evaluation (ASPE), the cost of specialty drugs has grown to more than $300 billion annually – and now represents more than half of all spending on drugs in the U.S.
Beyond just the high costs, the traditional process of filling specialty medications also has created frustrations for stakeholders. Healthcare consumers often must wait weeks to get their medications; pharmacies receive prescriptions they're not able to fill; payers unnecessarily pay higher claims for the same drug; and everyone pays higher fees when another lower-cost pharmacy was an option.
Waltz sees efficiency as one of the keys to resolving these issues. When any specialty prescription for a member is submitted – regardless of the receiving pharmacy's network status with the payer – the new software reroutes it to the best pharmacy option based on each member's benefit design and a weighted list of attributes (price, turnaround time, fulfillment accuracy, members experience, adherence rates, etc.). These attributes can be adjusted by drug class or specific drugs, the company said.
The software also captures information payers can use, including details on the member's condition, prescription onboarding, contact details for the selected pharmacy, expected fulfillment turnaround time and number of refills.
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.
