Troy Medicare Files for IPO Following $5M Series A to Expand Pharmacist-Led Chronic Care Model

VCBeat (WeChat Official Account: vcbeat) has learned that Troy Medicare, a health insurance startup based in North Carolina, USA, recently announced it had raised $5 million in Series A financing to support the Medicare Advantage plan it launched in North Carolina in 2019.

On September 1, 2018, Troy Medicare raised $1.2 million in a seed funding round, bringing the company’s total fundraising to $6.2 million.

Troy Medicare was established on September 1, 2018, and is headquartered in Charlotte, North Carolina. The company is dedicated to ensuring that community pharmacies play a leading role in the healthcare of every senior citizen, making pharmacists and physicians central to the healthcare decision-making process for each enrolled member.

At Troy Medicare community hospitals, pharmacists regularly provide chronic disease management for patients. This includes reviewing patients’ medications, medical conditions, vital signs, and over-the-counter drug lists; examining recent medical records; developing care plans; and documenting every interaction with patients. By leveraging this proactive communication between pharmacists and patients, community pharmacies play a significant role in improving patient health outcomes, thereby reducing overall healthcare costs.

As a health insurance company, Troy Medicare pays fair dispensing fees ranging from $4 to $10 to in-network community pharmacies and compensates pharmacies $360 to $500 per member annually for clinical services, thereby reducing healthcare costs for Troy Medicare enrollees. By managing patients’ overall health, Troy Medicare lowers the per-patient healthcare expenditure.

Furthermore, Troy Medicare is the first Medicare plan provider to offer transparent drug pricing standards based on the National Average Drug Acquisition Cost (NADAC). In early 2019, Troy Medicare signed an agreement with its Pharmacy Benefit Manager (PBM) to use NADAC as the reimbursement basis for all member prescriptions. By adopting the publicly available NADAC pricing standard, Troy Medicare enables pharmacies and patients to clearly understand the price of each medication.

To date, more than 40 pharmacy owners, physicians, and healthcare professionals have invested in Troy Medicare, with these community pharmacies collectively holding over 50% ownership of the company. Among insurers offering Medicare Advantage plans nationwide, Troy Medicare is the only one in which community hospitals hold more than 50% ownership.

Flaviu Simihaian, CEO of Troy Medicare, stated, “We are launching a game-changing healthcare model that delivers better health outcomes for seniors by reducing medication costs. Pharmacists are the most trusted and accessible healthcare providers, and Troy Medicare is the first healthcare company to leverage this unique relationship to lower total healthcare costs. By providing chronic disease management, smoking cessation, and diabetes prevention programs, pharmacists have reduced hospital readmission rates for patients with complex care needs by 45%. Troy Medicare provides the technology, data, and business model to empower pharmacists to deliver these clinical services to members.”

(Compiled by Wang Yi)