Rightway Introduces New PBM Model With RightwayRx

Rightway is a technology and services company on a mission to simplify the healthcare experience. Its care navigation and pharmacy benefits solutions are delivered through a consumer-centric app that pairs every member with a live, clinician-led care team.

By combining expert, human guidance with intuitive technology, Rightway drives members towards the best care and medication at the best price while eliminating wasteful and preventable spend. Advanced claims analytics enable Rightway’s health guides to proactively engage high-risk members and close care gaps.

Rightway recently raised $100 million in Series C financing at a valuation of $1.1 billion. The round was led by Khosla Ventures, with participation from Thrive Capital, Tiger Global Management, and other existing investors.

The investment will be used to rapidly expand Rightway’s footprint in the employer market and accelerate its advancement across health plans, third-party administrators and other strategic channels.

The funding will also advance the build of RightwayRx, Rightway’s new-to-the-world PBM that is rearchitecting the broken pharmacy benefits model by realigning stakeholders across the supply chain, enabling risk- and condition-based engagement, and driving optimal medication utilization through proprietary clinical protocols.

Rightway charges a per member per month fee for both its navigation services and its PBM. This fee structure means it can offer drugs at cost, rather than spread pricing or rebates, like many traditional PBMs. The navigation platform has developed a proprietary quality rating system that looks at things like procedure counts, complication rates and readmissions scores to figure out where to steer members to get the best care.

Also, First Choice Health (FCH), a provider-owned health care organization, recently announced a strategic partnership with Rightway, giving FCH members direct access to Rightway’s innovative technology platform and team of health care navigators.

FCH’s integration of Rightway as part of its core offering helps members find care providers; review background information on doctors; avoid unexpected out-of-pocket costs; understand bills and schedule appointments all within a simple, user-friendly platform.

Rightway’s clinical navigation team is made up of doctors and nurses who, with the help of their support staff, answer member questions and serve as their single point of entry into health care. Rightway became available to select FCH members on Jan. 1, 2020.

Takeaway: Rightway has signed on 865 employer customers, which total more than 500,000 employees—a number it hopes to grow to 1 million by the end of the year