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WithMe Health: Delivering a Better Medication Experience
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Joe Murad, President and CEO , WithMe Health
“WithMe Health is taking a fresh approach to pharmacy benefits. We don’t have any hidden sources of revenue and don’t play pricing games, so employers and patients can come first,” begins Joe Murad, the WithMe Health CEO.
For years, the pharmacy benefits industry has failed to adequately serve plans and members. PBM profits continue to grow while medication costs rise and employer satisfaction declines. “A recent survey of employers shows that 4 out of 5 benefits leaders think PBMs are untrustworthy,” states Murad. “For a crucial employee benefit, that’s just not acceptable.”
Put simply, pharmacy spend is a function of Price x Utilization – how much medication costs and how often members fill prescriptions for those medications. Traditional PBMs focus on price; they don’t focus on utilization. In fact, they benefit from higher drug volume because they make more money from spread pricing, dispensing, and volume-driven rebates. However, utilization is actually driving 75%+ of the growth in pharmacy spend. With traditional PBMs controlling 80%+ of the market, it’s unsurprising that pharmacy spend continues to rise.
Employers are increasingly turning to PBMs that ‘pass through’ all rebates to their clients, knowing they can still get competitive pricing along with increased transparency. Furthermore, employers are seeing the value of proactive guidance that helps members navigate the complexity of the medication journey, optimizing medication utilization in the process.
WithMe Health provides both offerings. Combining a modern PBM with personalized medication guidance, WithMe Health lowers pharmacy spend for employers and their employees and improves health outcomes. They take a fully transparent approach to price and have a deep focus on utilization. “We act as an advocate for members, proactively reaching out to them to share the optimal medication options available, identifying both savings opportunities and quality of life improvements,” adds Murad.
Murad has been in the digital health space for most of his career, having been a founding team member or leader of four transformative startups, including Extend Health (acquired by Willis Towers Watson) and PokitDok (acquired by Change Healthcare). He took over the reins at WithMe after seeing the unsustainable growth in pharmacy spend and the pricing games played by other PBMs. Employers feel a genuine lack of control over their pharmacy benefits, which will only be exacerbated by novel therapeutics in the manufacturers’ pipelines and specialty pharmacy spend growing at 15% annually. WithMe is helping employers regain that control.
I’m so grateful. You actually cared. I really appreciate what you’ve done.
As a PBM, WithMe aligns incentives with those of the plan sponsor and its members. Unlike traditional PBMs that have volume-based pricing schemes, WithMe uses a single PMPM fee as its only source of revenue.
As a personalized medication guidance company, WithMe goes beyond conventional utilization management. Grounded in evidence-based medicine, WithMe’s clinical rules set and analytics engine identifies opportunities for increased formulary compliance, therapeutic alternative switches, lower-cost site of fill/care, and a range of disease management interventions.
WithMe’s analytics engine uses rich member profiles created through a data pipeline that consumes not only pharmacy claims data but also medical claims, SDoH, and self-reported outcomes data. The ever-evolving rule set is applied to these profiles, and tasks are generated for Medication Guides (pharmacists and pharmacy technicians) to reach out proactively to members, sharing clinical and cost-savings recommendations. The Guides’ job is made easy with a purpose-built operational CRM platform, which aggregates and organizes all the member’s information and intervention opportunities in a single place. This enables Guides to have a meaningful impact on members’ experience. One member, who was brought to tears of gratitude in her call with a Medication Guide, put it this way: “I’m so grateful. You actually cared. I really appreciate what you’ve done.”
For the growing cohort of members who prefer to navigate opportunities on their own with the help of technology, WithMe has developed a consumer-grade mobile app that shares the clinical and cost savings opportunities that a Guide would otherwise raise with them.
Going forward, WithMe will continue to bring its deep expertise in pharmacy benefits and medication guidance to partners in the ecosystem so that members can have a more integrated healthcare experience. And the market is taking note, too: as of 1/1/22, WithMe will have 10x the number of lives on the platform vs. the previous year, as more clients and increasingly larger clients are signing on to use their services.
Management Joe Murad, President and CEO and Shane Giuliani, Vice President, Marketing, WithMe Health
Description WithMe is a modern PBM and a personalized medication guidance company. PBM customers get both offerings, while plans that aren’t ready to replace their PBM can have WithMe’s personalized medication guidance sit on top of their existing PBM. By combining a modern PBM with personalized medication guidance, WithMe lowers pharmacy spends and improves health outcomes. It takes a fully transparent approach to price and has a deep focus on utilization. Unlike traditional PBMs, WithMe strives to deliver a better member experience by placing them at the forefront of the decision-making process.
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