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For a growing number of Americans, a serious diagnosis or unexpected trip to the emergency room can create a severe financial burden. Research from the Kaiser Family Foundation found that 72% of patients with household incomes under $40,000 would not immediately be able to afford a $500 unexpected medical bill. Additionally, more than 100 million US adults struggle with healthcare debt and there is more than $195 billion owed nationwide. Despite 91% of Americans having health insurance, the highest number in history, 27% skipped treatment due to cost concerns. More people now are avoiding the health system due to cost concerns than fear of getting COVID during its peak.
Chronic conditions such as cancer are extremely expensive for patients and can result in unmanageable treatment costs that lead to poor outcomes, and in some cases morbidity when care is avoided or delayed. Even among patients with commercial or public insurance, 16% were found to quit their treatment plans because they could not afford life-saving chemotherapy drugs, and patients with higher copayments were 42% more likely to skip treatment. Other conditions such as multiple sclerosis (MS), place a large financial burden on patients and their families. MS patients face a total lifetime treatment cost of $4.1 million, ranking second after patients with congestive heart failure in direct all-cause medical costs for chronic conditions. Among medically bankrupt families, MS is reported to be associated with the highest out of pocket expenditure (average of $34,167), and more than half of MS patients lose their ability to generate incomes within a decade following the diagnosis. Additionally, diabetes, obesity, asthma, COPD, stroke, and HIV drugs account for 42% of total high-cost prescriptions (>$125 copay).
In 2023, America spent $4.7 trillion on healthcare or $14,100/person annually. That’s enough to make it the fourth largest global economy ahead of Germany and Japan.
These statistics paint a gloomy picture of the spiraling costs of our system and the state of the financial health for all consumers. We see a powerful solution in TailorMed — an innovative company dedicated to addressing these issues and assisting patients in obtaining and adhering to high-cost medications – which is why Windham is excited and honored to lead the Company’s Series B financing.
Founded in Tel Aviv with headquarters in New York City, TailorMed has developed a financial navigation and assistance platform to address growing financial needs and distress among patients. TailorMed’s solution is a comprehensive platform offering benefit investigation, out of pocket cost estimation, financial assistance matching (to government-funded and philanthropic sources), insurance optimization, medication assistance, and automatic enrollment for patients in relevant programs. The platform uses analytics to understand a patient’s financial situation and out-of-pocket expenses, then automates the processes of exploring eligibility in available funding programs that can share or cover the expenses incurred by a patient (e.g., Medicaid, charitable foundations, drug assistance programs, personalized plan optimization, etc.). TailorMed’s analytics capabilities also enable providers to surface patients with the highest financial vulnerability, shifting financial assistance and revenue cycle management from reactive matching and harsh collections to proactively identifying and enabling the patient to reduce out of pocket responsibility. The financial assistance landscape is a market opportunity of nearly $60 billion annually, consisting of government programs, manufacturer free drug benefits, co-pay assistance programs, foundation assistance, and living expense benefits.
For patients, this helps eliminate downstream financial hardships, allows adherence to life-saving care and, for providers, can significantly decrease bad debt and write-offs. For pharmacies, TailorMed’s solution streamlines ordering and management of free drugs and proactive inventory scheduling. This helps to reduce prescription abandonment by patients at pharmacies and increases drug adherence by making medication more affordable. TailorMed’s offering to pharmaceutical manufacturers allows for real-time tracking of assistance program. TailorMed provides a solution in which these organizations can measure direct ROI and engagement.
TailorMed has demonstrated success in the market as they serve thousands of customers across the ecosystem, including top 10 pharmaceutical manufacturers, continue to grow revenue year over year, and have impacted tens of millions of patients.
We firmly believe that no family should go bankrupt because a loved one got sick.
We are humbled to partner with a passionate and growth-oriented management team and strategic syndicate partners to take TailorMed to its next stage of growth. Here’s to alleviating the medical debt burden for too many patients across the US!
