Develop Health, a benefits verification and prior authorization platform, has raised $14.3 million in Series A funding, the company announced on Wednesday.
The San Francisco-based company’s platform can check coverage and prior authorization requirements for multiple drugs. It also creates AI-generated answers for prior authorization requests and allows providers to review them before submitting. When a payer sends a prior authorization determination, the provider is immediately notified. Some of its clients include digital health companies Ro, LifeMD and Sunrise.
“Today, providers waste hours of their day digging up the right forms [for prior authorization]filling them out by hand, faxing them back and forth, and then waiting on hold with payers,” said Mel van Londen, co-founder and CEO of Develop Health. “It’s slow, repetitive, and pulls time away from direct patient care. Develop plugs straight into the EMR and prescribing workflow, displays coverage checks in real time, auto-fills and submits the right prior auth package, follows up automatically, and pushes results right back into the provider’s system.”
The Series A funding was led by Wing Venture Capital, and included participation from Afore Capital, J Ventures and South Park Commons. In total, Develop Health has raised $17.6 million.
According to one investor, Develop Health is addressing a significant unmet need.
“Develop Health is solving one of the most frustrating pain points in healthcare – getting patients the medications they need without weeks of paperwork and endless back-and-forth,” said Sara Choi, partner at Wing Venture Capital, in a statement. “They’ve built a system that puts GenAI to work in one of the industry’s most critical, overlooked workflows. Develop Health is positioned to become essential infrastructure for any provider dealing with medication access complexity.”
The financing will help the company build on its integrations with electronic health records and pharmacy benefit managers so that coverage checks and prior authorizations become more efficient, according to Londen. The startup is also looking to expand beyond medication access into the medical benefit space, including for labs and imaging.
In addition, the funding will support Develop Health in building “the go-to-market muscle we need to bring these capabilities beyond digital health and into more traditional provider settings,” Londen said.
The prior authorization process is often a point of contention between payers and providers. Payers say it’s needed to ensure care is appropriate and cost effective, while providers argue that it creates harmful delays in care and adds administrative burden.
For Londen and co-founder Benjamin Easton, this work is “really personal,” Londen stated. The two previously worked at provider-facing startups Canvas Medical and Rupa Health.
“Through our own families — and our time spent inside the healthcare system — we’ve seen how frustrating it is when the right treatment gets delayed by paperwork,” Londen said. “At the end of the day, a prescription that isn’t covered or affordable isn’t much of a prescription at all. And those delays matter: it can be the difference between someone starting treatment tomorrow or waiting weeks.”
Several other companies are also trying to remove the complexity in prior authorization, including Cohere Health and Rhyme.
Photo: nito100, Getty Images
