Lark Health is rolling out a new, artificial-intelligence-enabled platform to manage the costs related to GLP-1s, and it has tapped a former insurance industry executive to lead the charge.
Matthew Gibbs, who previously served as chief pharmacy officer at Blue Shield of California, will join Lark as president. In that role, he will spearhead the launch of LarkVantage, a platform designed to mitigate the challenges associated with utilization reviews for GLP-1s.
At Blue Shield, Gibbs led the insurer's Pharmacy Care Reimagined initiative, which saw it break out of the traditional pharmacy benefit management model and instead lean on a menu of vendors to contribute different pieces of the puzzle.
He told Fierce Healthcare that he previously spent a year as an advisor to Lark and decided to join the team given the opportunity in the metabolic care space.
"It let me really stretch into the dev-tech side with artificial intelligence, but leveraging my knowledge of the PBM, health plan industry in terms of their major challenges, both clinically and from a cost standpoint, with both cardiometabolic and, in particular, weight management at this stage," Gibbs said.
LarkVantage offers payers real-time biometric data they can use to more easily make eligibility determinations. The tool aims to reduce the need for back-and-forth with providers on key data, accelerating the process of prior authorization or other utilization management reviews.
Gibbs said that given the recent interest in these products, it's led to a significant increase in the authorization requests coming from providers around GLP-1s.
He said it's not uncommon for these requests to come in with an "urgent" marker, though they may be for weight loss. Given that plans want to be in compliance with requirements around these submissions, an urgent request requires a quick turnaround time.
LarkVantage is designed to accommodate that potentially tight window, he said.
"You're not faxing to the doc, you're not calling to verify, you're not trying to dig through an EMR," Gibbs said. "It really provides you with that real access."
Lark is currently piloting the platform with some of its national and regional pharmacy benefit management clients, the company said in an announcement. LarkVantage also represents the next evolution for its work in the AI space, with agentic programs as a key focus.
Gibbs said a company like Lark has a right to play in the utilization management arena because it's not tied to the incentives driving either payers or providers in these negotiations.
"We're not a PBM, we're not a health plan," he said. "At the end of the day, we're an AI digital healthcare company that can leverage what we're learning and the data that we're receiving, and power that for the end user."
"There's a lot of perverse incentives, and we don't really have any," Gibbs added.
Gibbs said that while the team is focusing on LarkVantage as a tool in the GLP-1 space for now, he sees the potential in other disease states such as oncology. He said integrating lab and testing data would also likely be a major boon in accelerating the utilization management review process.
"I don't necessarily speak about too much internally, because I really like people to focus on and making sure what we're doing is going to be near perfection," he said. "But I think it's got an endless application."