The money is allocated. The adoption isn't there yet.
Medication non-adherence is one of the largest, most expensive, most solvable problems in U.S. healthcare.
Medicare now pays providers to monitor it — and that spend is climbing fast. Yet remote monitoring still reaches
only a sliver of the patients who need it. That gap, between funded and adopted, is the whole opportunity.
The problem is enormous — and well measured
~50%
of patients with chronic disease take their medication as prescribed, in developed countries (WHO). 1
$100–289B
estimated avoidable U.S. healthcare cost each year from medication non-adherence. 2
~125,000
premature U.S. deaths a year attributed to non-adherence (some estimates run higher). 2
~93%
of Medicare spending goes to managing chronic disease (2022). 3
~2 in 3
Medicare beneficiaries have 2+ chronic conditions requiring ongoing medication. 3
$528B
broader annual cost of non-optimized medication therapy, U.S. (2016 model). 2
The striking part isn't just the size — it's that the failure point is so simple. A large share of this cost comes not from
the wrong drug or a missing therapy, but from a prescribed medicine that the patient, at home, simply doesn't take. The signal
needed to catch it — did a dose actually happen? — is exactly what traditional care can't see.
Medicare already pays to fix it
There are billing codes built for adherence monitoring
This isn't a market waiting on permission. In late 2022 the AMA created Remote Therapeutic Monitoring (RTM) codes —
98975–98981 — explicitly covering the monitoring of medication-therapy adherence and response, alongside the older
Remote Physiologic Monitoring (RPM) codes (99453–99458). Medicare reimburses setup, the monitoring device/service, and
the clinical time spent managing the patient each month. 4
In other words: a specialty pharmacy or provider that monitors whether a patient is taking their medicine has a
defined, recurring way to get paid for it — by Medicare, by many Medicare Advantage plans, and increasingly by
commercial payers and state Medicaid programs. 4
Beneficiaries grew ~10× from 2019 to 2023, then roughly doubled again by 2024. 5, 6
~$536M
Medicare RPM payments in 2024 — up ~31% over the prior year. 6
+3,000%
growth in Medicare RPM claim volume across just four years. 5
$6.8M→$194.5M
traditional-Medicare RPM spend, 2019 to 2023. 5
But adoption still reaches almost no one
Roughly 1 million reached — out of tens of millions who qualify
Here is the gap. About 1 million Medicare enrollees used remote monitoring in 2024. But roughly
two-thirds of ~67 million Medicare beneficiaries — on the order of 40+ million people — live with multiple
chronic conditions and ongoing medications. 3, 6
And the providers actually doing it are concentrated: federal watchdogs found only about 4,600 practices routinely
billing RPM nationwide, even as ~46% of hospitals say they offer it. 6 The capability exists and is
reimbursed; it simply hasn't reached the patients.
The dollars are allocated. The codes exist. The clinical need is overwhelming. What's missing is a way to
actually put monitoring into the hands of ordinary patients at home — which is the problem LIVIT was built to solve.
The math: many came, few stayed, the gap held
Here is the part that keeps everyone at peace. Since 2016 this has been one of the most-attempted problems in health
tech — and the attempts mostly didn't close it. More than 800 companies have taken on medication adherence; only
about 230 ever raised funding, and just ~79 reached Series A or beyond. Roughly 41 new companies
launch into this space every year — and the field keeps thinning faster than it fills. 7
Of 800+ entrants, the survivors that truly scaled adherence monitoring number in the handfuls. 7
$1.5B→$0
Proteus Digital Health — the marquee "smart pill" — raised $500M+, hit a $1.5B valuation, and filed Chapter 11 in 2020. 8
$29.3B→$10.1B
U.S. digital-health venture funding fell by roughly two-thirds from its 2021 peak to 2024. 9
966
startup shutdowns in 2024, up ~26% over 2023 — the field is contracting, not consolidating into a winner. 10
And after all of it — the 800 companies, the billions invested, the unicorn that went to zero — the gap on the
ground did not close. Remote monitoring still reaches on the order of ~2% of clearly-eligible Medicare patients, and the
cost of non-adherence is still measured in the hundreds of billions. A great deal of money has chased this problem; very little
of it actually reached the patient at home.
Hundreds tried, a handful scaled, and the gap barely moved. That isn't a crowded market that's been won —
it's an open one that nobody has cracked.
The lesson in the wreckage is consistent: the winners weren't the most clever
sensors — they were the ones that fit a real payment model and an existing care workflow. Proteus failed on cost, evidence,
and adoption, not on engineering. That is exactly the seam this work was built against.
The 10-year scoreboard — adherence as the core
Narrow it to the exact question: companies whose core was medication adherence / compliance, over the last decade —
how many started, how many succeeded, how many failed.
~800
companies took on medication adherence (~41 new a year); the device-centric subset alone is ~208 (~9 new a year). 7
under a dozen
reached a real exit or durable scale — and most of those were access, price, or packaging plays, not dose-level monitoring. 7, 16
the rest
failed, went dormant, or never raised: ~570 were never funded, and only ~79 ever reached Series A+. 7
The named outcomes tell the story plainly:
Succeeded (acquired, adherence-adjacent): CoverMyMeds → McKesson ($1.1B), PillPack → Amazon ($1B), Propeller Health → ResMed ($225M), Mango Health → TrialCard, HealthBeacon → Hamilton Beach (2024). 16
Failed / wound down: Proteus Digital Health — bankrupt after $500M+ raised; and even the "successful" Propeller was later ceased post-acquisition, ResMed keeping only the brand and IP. 8, 16
Still independent, never broke out: Medisafe (~$51M raised), AdhereTech (~$2.4M), AiCure, AdhereHealth — and a long dormant tail behind them.
In ten years, pure "did the patient take the dose" monitoring produced essentially no durable, standalone
winner. The money that did get made was next door — in prior-authorization, price, and packaging.
Counts are category totals (medication-adherence startups and the device subset);
"succeeded" counts companies with a disclosed acquisition or sustained public-market scale. Several "adherence" exits were
adjacent businesses (prior-auth, discount cards, mail-order packaging) rather than dose-level adherence monitoring — which is
itself the finding. 7, 16
The anatomy of the money
Now the part that should reframe how you think about this market: the size of the check did not decide
the outcome. Some of the largest raises in digital health went to zero, while the field still hasn't solved the problem.
This is what the capital actually did.
Raised — then gone
These are not scrappy seed-stage flameouts. Each of these companies raised hundreds of millions, several were called
unicorns — and each one is now shut down, bankrupt, or sold for scrap. For scale, the last bar is where an independent,
lightly-capitalized founder sits.
Approximate reported lifetime funding. All five raised at venture scale; all five are gone. 8, 11, 12
$400M→$6M
Pear Therapeutics raised $400M+, SPAC'd at a $1.6B valuation — assets later sold at auction for ~$6M. 11
$389M
debt Babylon Health reported in its 2023 Chapter 7 filing, after unicorn status. 11
~30%
of digital-health companies that went public via SPAC had filed bankruptcy by 2025. 12
B2B vs. B2C: the consumer model quietly lost
The other structural lesson is about who pays. Selling a health product directly to consumers (B2C) looked obvious and
almost never worked; the durable model is selling to the payer, pharmacy, or provider (B2B / B2B2C). The migration is stark:
A third started B2C; most abandoned it. When digital health works, it works B2B. 13
Where the capital actually went
Yes — "how much was raised" looks very different once you split it by model. The dollars didn't divide evenly; they
concentrated in B2B. About 77% of all digital-health venture funding went to B2B companies, and the average B2B
round was larger too.
Capital went where the durable business was. 13
77% / 23%
share of digital-health venture dollars, B2B vs. B2C. 13
$11M / $9M
average venture round size, B2B vs. B2C. 13
61% pivoted
of the 34% that started B2C — 45% moved to B2B2C, 16% to B2B; only 14% stayed pure consumer. 13
The revenue winners — and which model they run
Survival is one lens; real revenue is another. These are the digital-health companies that actually built durable top
lines. Sorted by model, the pattern is hard to miss: the profitable, durable revenue clusters in B2B — and even enormous B2C
revenue can run at a deep loss.
Company
Model
What they sell
Recent annual revenue
Profitable?
B2B / B2B2C — sell to payer, provider, pharma, or employer
Veeva Systems
B2B
Life-sciences cloud software
$2.75B
Yes — net income ~$0.8B
Doximity
B2B
Clinician network + pharma marketing
$475M
Yes
Phreesia
B2B
Patient intake for provider orgs
$356M
Yes (reached FY25)
Hinge Health
B2B2C
Employer-paid MSK care
$390M
Near breakeven · IPO '25
Omada Health
B2B2C
Employer-paid chronic-condition care
$170M
Losses narrowing · IPO '25
B2C / DTC — sell directly to the consumer
Hims & Hers
B2C
DTC telehealth + pharmacy
$1.46B
Yes — first full year
GoodRx
B2C
Consumer prescription-price marketplace
$792M
Yes (adjusted)
Teladoc Health
B2C-heavy
Telehealth + BetterHelp (DTC)
$2.57B
No — ~$1.0B net loss
Most recent reported fiscal-year revenue (FY2024–FY2025 depending on company). Note
what's missing: almost none of these are pure medication-adherence companies — the largest durable revenue in digital
health sits in adjacent B2B niches, while adherence itself stayed unsolved. That absence is the point. 14, 15
What the analysis actually says
Put the layers together and a counter-intuitive picture emerges. Capital was abundant and is now scarce. The biggest
checks produced some of the biggest failures. The consumer model collapsed; the business that survives is the one wired into
a payer or pharmacy. And through all of it the clinical gap — patients not taking their medicine — barely moved.
The decisive variables weren't dollars raised or cleverness of the device. They were business model
(B2B, reimbursed) and fit (into a real care workflow) — the two things a small, disciplined team can get right without a
billion dollars.
That is the honest case for a lightly-capitalized effort in this space. Not that money doesn't matter — it does — but that
this particular problem has repeatedly defeated money, and has never been beaten by it. It rewards a narrow wedge: a specific
payer, a specific pharmacy workflow, a reimbursable code, and a device that an ordinary patient at home will actually use.
That is the wedge LIVIT was built against →
Company funding figures are approximate reported lifetime totals drawn from public
reporting and may mix primary capital, SPAC proceeds, and valuation milestones; they are shown to convey order of magnitude,
not audited amounts. The independent-founder bar is illustrative of the lightly-capitalized end of the market and is not a
specific company's disclosed figure.
Where SharkDreams sits in this picture
The unique position
B2B-native adherence — built as a platform, not a product
Read the analysis back and a profile of "what works" falls out: be B2B, be reimbursed, fit a real
workflow, and expand your product surface over time. The striking thing about SharkDreams is that it didn't have
to pivot into that profile — it started there.
B2B from day one — no pivot required. While 61% of the companies that began B2C scrambled to become B2B or
B2B2C, LIVIT was sold to the specialty pharmacy, never to the patient. It was already on the side the whole market
migrated toward.
Reimbursed by design. The adherence signal maps to RTM — a defined Medicare payment path — instead of
depending on consumer willingness-to-pay, the trap that sank most B2C plays.
Wired into a workflow. A pharmacist-in-the-loop dashboard, not an app fighting for a consumer's attention.
A platform, not a single product. The device plus the five-link architecture were rails. Adherence was
meant to be the first product; the vitals patch and further monitoring were designed to ride the same B2B pipes —
adding value per patient without re-acquiring the customer.
One set of B2B rails; adherence first, more digital products on top.
That is the difference between SharkDreams and most of the names on this page. The market spent a decade and tens of
billions learning that adherence has to be B2B, reimbursed, and workflow-fit before it can scale — and that the real
upside is a platform you can extend. SharkDreams was architected against that conclusion from the start.
Why adoption lags — and where the wedge is
The barrier isn't reimbursement. It's reach.
The hardest patients are the least digital. The chronic, older, lower-income, dual-eligible patients who most
need monitoring are the least likely to set up an app, a device, or reliable home connectivity — so they fall out of
enrollment first. (This is the adoption question →)
Device + workflow friction. Programs stall on hardware logistics, patient onboarding, and fitting monitoring into
a pharmacist or clinician's day — not on whether the service pays.
Concentration, not diffusion. A small number of practices have figured out the operating model; the vast
majority haven't, leaving most eligible patients unreached.
Oversight is tightening. Federal scrutiny of RPM billing is increasing — which rewards programs built on
real, device-grounded evidence of monitoring rather than thin engagement. 6
Each of these is an execution problem, not a demand problem — which is the encouraging part. The reimbursement is real and
growing; the unmet need is enormous; the bottleneck is a device-and-software model that actually works for a non-technical
patient at home, and a pharmacy workflow that turns the signal into action. That is precisely the seam LIVIT was designed
against.
B2B vs. B2C migration and capital share (77% of funding to B2B; avg round $11M B2B vs. $9M B2C; 34% began B2C, 61% pivoted [45% to B2B2C, 16% to B2B], ~14% still B2C; ~70% pilot-to-paying) — The Future of Health; Rock Health.
Revenue — Veeva (FY25 $2.75B; FY24 net income ~$791M); Doximity (FY24 $475M, profitable); Phreesia (FY24 $356M, profitable FY25); Hinge Health (2024 $390M); Omada (2024 $170M) — company filings / SEC; MedCity News (Hinge/Omada).
Figures are drawn from public studies, federal reports, and industry summaries and cite different scopes and
years; they are presented to convey magnitude and trend, not a single audited series. Nothing on this page is an offer to
sell or a solicitation to buy any security or investment, and it is not legal, financial, or medical advice.
SHARKDREAMS