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The Next Next-Gen PBM? Healthcare Navigation Biz Rightway On Making The Pivot

BY JESS DaMASSA, WTF HEALTH

More traction in Pharmacy Benefits Management (PBM) innovation, this time coming out of care-navigation-plus-PBM startup Rightway. CEO Jordan Feldman and Chief Pharmacy Officer Scott Musial (who Jordan calls the “Godfather of PBMs”) drop in to talk about their 1500 employer client base and how the business is now even winning over health plans who are tired of working with the ‘Big Three PBMs.’

The NextGen PBM story is the headliner here, with Rightway customers saving an average 18% in their first year with the “new-to-the-world PBM” the company has built.

What’s different? Two big things. First, the PBM’s payment structure for the employer. Jordan shares how these are usually rebates-driven or based on spread pricing; Rightway is actually innovative in offering the PBM benefit on a per-member-per-month basis instead.

That leads to the second twist, which is based on gaining cost savings for the employer by pairing the PBM with navigation. According to Scott, this changes the conversation from one that’s solely focused on managing the price of the drugs to managing how employees are utilizing the formulary instead – creating opportunities for lower-priced generics or alternatives that Rightway is happy to point to because it’s not dealing with rebates or dispensing.

So, who is Rightway competing with? Navigators like Accolade, Inc. or Included Health? PBMs like CVS/Caremark, Optum or Express Scripts? Or other emerging ‘combo’ businesses like Transcarent?

We get into the competitive landscape, more about PBMs than you might have ever wanted to know, and what Jordan and Scott are hearing from hard-hit employers looking to recruit and retain employees in the face of the Great Resignation.

#Healthin2Point00, Episode 196 | Rightway, AKASA, Viz.ai, AppliedVR, & Harmonize

We’ve only got one $100 million deal today on Health in 2 Point 00 — has the bubble burst? On Episode 196, Jess and I talk about care navigator Rightway raising $100 million – there’s a lot going on with this space, does it make sense to do this right now with Transcarent? AKASA, formerly known as Alpha, raises $60 million bringing its total to $85 million for revenue cycle management. Viz.ai gets $71 million, bringing its total to $150 million, for its stroke diagnostic AI software, AppliedVR raises $29 million bringing its total to $35, and Harmonize Health raises $10 million working on remote patient monitoring. —Matthew Holt

Meet Rightway: The Little-Known $1.1B Care Navigator PBM Startup That Just Scored $100M

By JESSICA DaMASSA, WTF HEALTH

Despite nearly 900 employer clients (including big brands like Burger King, Kroger, and DoorDash), a net promoter score of 84, and a new pharmacy benefits management (PBM) program launched mid-pandemic, healthcare navigator startup, Rightway, seems to have come out of left field with its $100M Series C fundraise and $1.1B valuation. CEO Jordan Feldman introduces us to the company he’s built and its pretty impressive ability to achieve double-digit decreases in the cost of healthcare for mid- and large self-insured employers.

We walk through the business model, talk about the well-funded competition in both the care navigation and PBM spaces, and get acquainted with Rightway’s plans for scaling up and attracting new clients. An added little point of intrigue? As Rightway looks to gain a foothold working with health plans, Jordan mentions some interesting ties via its Series C investors. While the round was led by Khosla Ventures, with participation by Tiger Global and existing investors, it’s Thrive Capital, also an investor in the health insurance startup Oscar Health, that sounds like it might help Rightway make its way into the payer market.

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