What You Should Know:

  • Waltz Health, a digital health company developing smarter, technology-enabled ways to price, distribute and prescribe medications, today announced its entry into the Medicare market.
  • The company will offer health plans that support Medicare beneficiaries customizable configurations of its proprietary Marketplace Search technology, which lowers prescription drug prices for members and improves their experience, while also providing health plans with critical insight into adherence trends.

Marketplace Search Revolutionizes Medicare Prescription Assistance

Waltz Health’s Marketplace Search is a customizable digital search engine leveraging AI technology, designed to optimize discounted drug pricing for various healthcare organizations such as health plans, PBMs, pharmacies, and self-insured employers, thereby enabling significant cost savings for their populations during prescription fills.

For health plans catering to Medicare beneficiaries, the utility of Marketplace Search varies based on individual requirements and member challenges. It serves as a robust and user-friendly tool empowering health plans to assist members in discovering savings on covered medications during coverage gaps, identifying cost-effective cash-pay alternatives for uncovered medications, and accessing patient-assistance programs tailored to the Medicare demographic.

The struggle with out-of-pocket drug expenses affects millions of Medicare beneficiaries annually, particularly underserved groups. Despite the availability of cash-pay options and patient assistance programs to alleviate member costs, these solutions are often obscure. Marketplace Search addresses this issue effectively, presenting a valuable platform that significantly benefits health plan members.

SCAN Health Plan, a prominent nonprofit Medicare Advantage provider, leads the way as the first payer to adopt a customized iteration of Marketplace Search specifically tailored for Medicare use cases.

Waltz Health’s bespoke tool serves as an online hub where eligible Medicare Part D members, entering a coverage gap, can explore prescriptions available at reduced cash-pay rates or through local pharmacy-based patient assistance programs. This marks the second distinct deployment of Waltz Health’s technology since its expansion into the payer, PBM, and self-insured employer sectors in September. While the initial deployment of Marketplace Search for Health Plan targets the commercially insured demographic, this subsequent deployment extends its reach to address the needs of Medicare beneficiaries.

Apart from its recent deployments within the health plan realm, Waltz Health has introduced unique iterations of Marketplace Search in four national pharmacy chains, spanning thousands of locations nationwide. These deployments have yielded average savings per prescription ranging from $5 to $10 more than alternative single prescription drug savings card solutions. Concurrently, the company is developing a specialty-drug solution for health plans aimed at enhancing transparency, reducing medication costs, elevating member experience, and ameliorating health outcomes for intricate specialty conditions, which constitute the fastest-growing segment of prescription spending in healthcare.

“Our tailored versions of Marketplace Search empower the members of Medicare Advantage plans with more choice and information when they’re searching for better prices on their prescription drugs, delivering savings for them and helping the plan with member retention,” said Waltz Health CEO and Co-founder Mark Thierer. “We’re honored to be working with such prestigious Medicare-focused health plan partners and look forward to helping them solve more unique use cases like coverage gaps.”