New platform helps payors and plan sponsors address one of the biggest drivers of healthcare cost increases.
NASHVILLE, Tenn., Jan. 7, 2026 /PRNewswire-PRWeb/ -- Ethicos Health, addressing the rising cost of specialty pharmacy by tying payment to real-world outcomes, today announces its launch and the closing of a pre-seed financing round. Investors include Flare Capital Partners, SWL Healthcare Ventures, Two Sons Investments and several angel investors with deep healthcare operating experience.
The cost of specialty medications has become one of the most urgent challenges in healthcare, with individual therapies costing tens or even hundreds of thousands of dollars per patient each year. What many don't realize is that a meaningful portion of these high-cost therapies are frequently ineffective for individual patients due to the highly targeted nature of specialty drugs. By ensuring that patients receive – and plans pay for – only medications that are clinically effective for them, there is a significant opportunity to improve patient outcomes and meaningfully reduce specialty pharmacy spend.
"Ethicos Health was founded to help health plans and employers align coverage decisions with whether a specialty medication is actually working for each patient, rather than relying on administrative checklists, rebates, or formulary positioning," said Mark McConnell, Co-Founder and CEO of Ethicos Health.
"Many newer entrants are using AI to make prior authorizations faster, but with the unintended consequence of accelerating already double-digit healthcare cost increases," said Mike Tudeen, former CEO of CareBridge and Founder at Two Sons Investments. "With Ethicos Health we saw a company that delivers real value for patients and payors through improved clinical outcomes, reduced paperwork and enhanced transparency by streamlining the specialty pharmacy prior authorization process."
Ethicos Health's platform enables health plans and plan sponsors to evaluate specialty medications based on the achievement of their intended clinical endpoints for individual patients. The platform supports certification and re-certification of therapies based on real-world clinical outcomes – nothing more, nothing less.
Patients on effective therapies can be fast-tracked or "gold carded," while those on ineffective treatments can pivot more quickly to alternatives that may provide benefit. For employers and plan sponsors, this approach creates a sustainable path to managing specialty pharmacy costs without restricting access to care.
"We're not going to solve the specialty pharmacy cost problem by denying access or adding more bureaucracy," said McConnell. "But if we focus on clinical effectiveness – and stop paying indefinitely for drugs that aren't helping patients – we can lower costs while getting people to therapies that actually work."
As biologics now represent approximately 75% of the FDA pipeline, specialty drug costs are expected to continue rising. Ethicos Health believes that grounding coverage decisions in clinical effectiveness is essential to maintaining access to life-changing therapies while keeping employer-sponsored healthcare affordable.
"We believe the future of prior authorization goes far beyond prescriber attestation and creating care barriers – it's about making decisions based on clinical efficacy and appropriateness. This approach can work alongside or through existing authorization infrastructures to deliver better outcomes," said Leigh Ann Ruggles, Co-Founder and Chief Growth Officer of Ethicos Health.
The company is currently working with transparent PBMs and health plans seeking new approaches to managing GLP-1 and specialty drug costs.
About Ethicos Health
Ethicos Health's AI-Enabled Clinical Efficacy platform transforms traditional prior authorization to make it more clinically effective while reducing specialty pharmacy costs for health plans, PBMs, their clients, and members. As a SaaS healthcare company, Ethicos empowers plan sponsors to improve patient outcomes and meaningfully reduce specialty pharmacy spend by measuring whether medications are actually working for members.
Learn more at www.ethicoshealth.com or contact us at [email protected].
Media Contact
Leigh Ann Ruggles, Ethicos Health, 1 4436822910, [email protected], www.ethicoshealth.com
SOURCE Ethicos Health
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