HealthPlan Data Solutions (HDS), a leader in pharmacy payment integrity and benefit optimization, announced a $15 million growth equity investment led by MK Capital. Existing investors Tamarind Hill, JobsOhio, and Rev1 Ventures also joined.
Value Proposition: Since its founding, HDS has saved payers millions and protected more than 8 million covered lives by identifying overpayments to Pharmacy Benefit Managers (PBMs), eliminating contractual gray areas, optimizing plan design, and helping uphold plan sponsors’ fiduciary responsibilities under ERISA.
With pharmacy costs continuing to climb, health plans and employers urgently need smarter, more proactive tools to monitor claims and control costs.
Claim Scan: HDS’ Claim Scan solution continuously monitors 100% of pharmacy claims in near real-time, using over 500 customizable algorithms to detect adjudication errors before they lead to excess costs. And unlike retrospective one-time audits, HDS offers continuous oversight, allowing plan sponsors to detect and recover claim-level errors before they escalate, uncover trends that expose contract misalignment or hidden overcharges, and strengthen PBM contracts to drive better long-term cost controls.
CEO Ron Hamm pointed out that clients should expect to see more automated workflows, additional Claim Scan algorithms, and ease-of-use improvements in the near future that will drive added value and efficiency to our near real-time pharmacy benefit review solutions.
KEY QUOTES:
“This investment allows us to expand our technology platform, develop more robust analytics, and enhance service capabilities so health plans and employers can take control of their pharmacy spend in real-time—not months after the fact. We can now fully realize our mission to bring transparency, accountability, and efficiency to pharmacy leaders searching for better answers in today’s opaque PBM review process.”
CEO Ron Hamm
“We are thrilled to partner with HDS at this pivotal time. With bipartisan calls for PBM reform and rising prescription drug costs, sophisticated payers recognize they have a responsibility to take back control of their pharmacy benefit. HDS’s solution pays for itself within months and provides customers the assurance that their members’ pharmacy benefit is being properly administered.”
Mark Koulogeorge, Managing Partner at MK Capital
