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Independent pharmacy Benefits manager CerpassRx is seeking to better manage specialty drug spending by partnering with Waltz Health on an artificial intelligence-based platform called the Intelligent Specialty Engine.
The idea is that the approach, which includes real-time analytical and specialty spend management capabilities, will improve transparency and facilitate the specialty drug experience for health plans and employers.
Data from the Assistant Secretary for Planning and Evaluation published in 2022, specialty drugs will account for more than half of total drug spending. 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 IS THE IMPACT?
According to CarepassRx, the new platform – described as a “unique” deployment of Waltz’s Connect technology – provides more flexibility and maximizes savings through 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 in-depth data analytics that provide real-time insights into cost savings, CarepassRx said, adding that it also streamlines the prescribing process.
“This collaboration with Waltz Health helps take our already unique specialty management capabilities to a new level,” said Eric Yonkus, President of CerpassRx.
Waltz Connect debuted earlier this yearand was designed to manage all aspects of a payer’s specialty drug coverage. It includes exclusive 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 freeing competition between specialty pharmacies; it is designed to reduce specialty costs, improve the 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, specific drug classes or even down to individual drugs.
THE BIGGEST TREND
Waltz Health entered the Medicare Advantage arena in Februaryoffering health plans that support customizable Medicare beneficiary 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-label digital search engine that applies AI to a curated mix of drug discount sources to help healthcare organizations – including health plans, PBMs, pharmacies and employers self-insured – to save their people money when filling prescriptions.
For plans that support Medicare beneficiaries, Marketplace Search use cases may vary depending on their needs. According to Waltz, it gives health plans a tool to help members save money on covered drugs when there is a coverage gap, find lower-cost, out-of-pocket solutions for drugs not covered by their plan and find Patient assistance programs available to the Medicare population.
Jeff Lagasse is editor-in-chief of Healthcare Finance News.
E-mail: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.