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RxLive

Pharmacy telehealth

USA, Florida
Market: Medicine, Pharmacology
Stage of the project: Operating business

Date of last change: 16.04.2020
Min investment
$  50.000
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Total required
$ 650.000
Rating
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Idea

Marketplace and telehealth platform of clinical pharmacists serving risk bearing physician organizations and employers.

Current Status

Since our go-to-market launch in the summer of 2018, we are live in 13 customers, and in implementation with an additional 6 with 3 additional deals expected to close in March. These include several large provider practices, 2 health systems, 1 ACO and 1 large employer – our first in that channel. We are currently in late stage contracting with 1 additional large health system. Cumulatively our commitments represent over 1000 MD’s. We have over 80+ additional opportunities in the pipeline, include mature deals spanning provider, health system, ACO, employer, hospital, lab and consumer channels representing over 100,000+ patients and $3MM+ in ARR.

Market

The market for in-depth pharmacist consultations is sizable ($3B+) and growing significantly as the Medicare and chronic disease populations expand. These macro trends all drive increasing pharmacy spend fueling the need for novel solutions for risk-bearing entities.

The market has multiple segments including:

• Traditional Medicare: $400M
• Medicare Advantage: $700M
• Medicare prescription drug plans: $700M
• Employer sponsored: $800M
• Medicaid: $100M
• Consumer: $400M
Several ancillary opportunities offer significantly additional profit potential:
• Direct data sales to pharma & biotech ($40M+ margin)
• Pharmacogenomic Counselling ($100M+ margin)
• Automation and Clinical decision support algorithms and software ($100M+ margin)

Problem or Opportunity

25% of all healthcare spend is on prescription drugs, and yet, 50% of patients are non-adherent to their medications because patients don’t: pick up their medications take their medications. In addition, most drugs are effective in fewer than 60% of treated patients due to genetic variation in how individual patients respond to and tolerate medications. These factors combine to drive over $300B in additional costs for the US healthcare system.
Intense pharmacist counseling leads to a 70% improvement in compliance as well as a 25% reduction in inappropriate drug use - which in turn delivers an 8:1 ROI.
Medicare markets are significantly under-penetrated and only 30% of eligible patients are receiving services today, and these are just once a year. We have pioneered and validated both a new approach and new Medicare reimbursement profile that dramatically expands this market (monthly vs. annually).

Solution (product or service)

Our services include:
• In-depth pharmacist counselling over videochat or phone
• Pharmacist integration into value-based reimbursement programs
• Pharmacy cost management for employers and payers

In addition, our proprietary technology platform focuses on medication behavior change and:
• Aggregates medication related, genomic, clinical and behavioral data across patients and providers.
• Uses real-time data to drive behavioral & clinical decision support
• Helps to isolate the unique medication compliance challenges and customizes in real-time the patient’s care plan, as well as patient & provider communications.
• Integrates telehealth for convenience and privacy.
• Leverages our “human cloud” of pharmacists to audit and augment these protocols & our behavioral algorithms.

We average 1-2 meaningful clinical medication changes per consult, resulting in a 3-4X ROI on drug cost savings alone. Our average customer satisfaction score is 9.3/10 reflecting the significant value we deliver to our patients and the quality of the overall experience

Competitors

Medication Therapy Management Vendors:
Our model disintermediates existing pharmacy services vendors who target health plans directly - including Mirixa & OutcomesMTM. These vendors serve at the direction of the health plans which results in misaligned incentives with providers and patients. Our model leap-frogs this approach by contracting with providers. By collaborating directly with providers both clinically and technologically, we solve the “last mile” of healthcare challenge.
Telehealth Vendors:
In the telehealth (MDLive, Teledoc) and telepharmacy spaces (PipelineRx), there are few, if any, established players with the combination of our specific channel strategy and product offering.
In House:
Organizations may develop the clinical pharmacist function in-house. We believe our virtual deployment model is a value-added alternative due to our novel reimbursement approach, technology platform, hiring model, and clinical guidelines resulting in a 33%-50% cost advantage.

Advantages or differentiators

1) Niche channel strategy & segmentation drives patient access and provider engagement
2) First Mover on regulatory/legal innovation allows us to build a brand in a large, very progressive and hugely influential market segment.
3) Our unique technology platform and behavioral algorithms
4) Cost advantage and human capital strategy leveraging remote and talented clinicians on a part-time basis.

Finance

We ave raised $1.45M to date in 2 convertible note rounds. We have grown 40% MoM for 4 consecutive months and will pass $200k in ARR in April.

Business model

• Providers: Fixed price per patient counseling session. Physician bills Medicare/commercial payer for each consultation, RxLive then invoices the physician.
• Employers & Payers: Fixed price PMPM, Pricing also available as PEPM or Per Enrolled Member. Also available on a per consultation basis.
• Consumers: Flat fee for consultation, or monthly subscription model per month.
• Data & Other Fees: Per data record (Pharma), Per completed & originated pharmacogenomic consultation

Money will be spent on

Funding will go towards sales and marketing expansion, building out the operations team and continuing to invest in our technology stack and core operating platform.

We expect the next raise to fund the business for 18-24 months such that in 2022 we expect RxLive to be one of the most progressive pharmacy organizations in the country with deep expertise in integrating virtual clinical pharmacists across multiple provider settings.

Offer for investor

Convertible Note with $850k already raised and a strategic corporate lead.

Terms:

$6.5M Cap
25% Discount
8% Interest
1.5X Liquidation Preference

Team or Management

Risks

Regulatory changes impact reimbursement. We are mitigating this through diversifying our distribution channel to include employers, consumers and other healthcare organizations.

Incubation/Acceleration programs accomplishment

Participant in: Tampa Bay Wave, Tampa Bay Embarc Collective, Florida Blue Guidewell Innovation Cohort

Won the competition and other awards

n/a

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Idea
Current Status
Market
Problem or Opportunity
Solution (product or service)
Competitors
Advantages or differentiators
Finance
Invested in previous rounds, $
Business model
Money will be spent on
Offer for investor
Team or Management
Mentors & Advisors
Lead investor
Risks
Incubation/Acceleration programs accomplishment
Won the competition and other awards
Invention/Patent
Photos
Product Video