Truveris Seeks the Truth in Pharmacy Benefit Claims

11/1/11Follow @arleneweintraub

Anthony Loiacono was hunting around for startup ideas a couple of years back when he came across a statistic he had a hard time believing: Every two weeks, $12 billion worth of pharmacy claims flows through the health-insurance system, and not a single one of those claims is checked for accuracy before it’s paid. “People just pay those invoices blindly,” Loiacono says. “I said, ‘That can’t be true.’”

From disbelief came Truveris, a company that Loiacono co-founded in New York with fellow entrepreneur Leon Greene in 2009. Truveris markets a software-as-service platform that enables health care payers such as insurance companies and large employers to review their pharmacy benefit manager (PBM) invoices for cost accuracy and other metrics prior to paying them. The product not only summarizes the claims in an online report, but it also provides tools for payers to reconcile any improper charges that are caught during the review.

The idea is clearly catching on. In the two years since it was founded, Truveris has attracted several big-name customers, including Northrop Grumman, Morgan Stanley, and AXA Equitable. It raised $3.8 million in a Series A round in February from GSA Venture Partners (now Tribeca Venture Partners), New Atlantic Ventures, and First Round Capital. On October 6, the company recruited a new CEO: Bryan Birch, whose experience includes running the health maintenance organization (HMO) Touchstone Health and managing employer accounts for pharmacy benefit giant Medco.

Birch has seen firsthand the inefficiencies inherent in pharmacy benefit claims. He learned about Truveris when he was CEO of Touchstone Health, an HMO for Medicare recipients. “Payers have no avenues for reviewing bills. When they protest, PBMs are reluctant to … Next Page »

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