Troy Medicare Pitch Deck (2019): 17-Slide Series B Deck

Troy Medicare’s 17-slide Series B deck focuses on a specific, high-leverage distribution advantage: the independent pharmacy. By positioning the local pharmacist as the primary care manager, Troy Medicare claims to bypass the massive advertising and broker costs that plague incumbents like UnitedHealthcare and Humana. The deck provides a clear breakdown of 'The Fat' in traditional Medicare Advantage—citing that marketing and brokers account for 70% of non-medical expenses—and counters it with a $0 CAC model proven by their first 250 members. With a leadership team boasting deep exits in healt…

Key takeaways

• Medicare Advantage is projected to surpass 40 million seniors by 2025, representing an $800 billion market size (Slide 3).
• Independent pharmacies represent 36% of all U.S. pharmacies, often located in underserved areas where seniors visit 36 times per year (Slide 4).
• Incumbent non-medical expenses are dominated by advertising (45%) and insurance brokers (25%), which Troy Medicare aims to eliminate (Slide 6).
• The company claims a customer acquisition cost (CAC) that is 20 times lower than the competition (Slide 7).
• Troy Medicare reached $3 million in ARR by January 2020 after enrolling its first 250 members at $0 CAC (Slide 8).
• Actuarial projections estimate EBITDA will turn positive in 2021 ($284,368) and reach $33.4 million by 2026 (Slide 9).
• The plan features $0 premiums, $0 deductibles, and $0 primary care visits to attract members (Slide 12).
• The leadership team includes the former CEO of iMedicare, which facilitated enrollment for over 1 million seniors (Slide 14).

Frequently asked questions

What is Troy Medicare's core value proposition?

Troy Medicare operates as a pharmacy-powered Medicare Advantage company. Its core proposition is to replace expensive, impersonal marketing and broker networks with the trusted, high-frequency relationship seniors have with their local independent pharmacists. By providing pharmacists with data tools to act as care managers, they improve patient outcomes while drastically reducing the cost of acquiring and maintaining members.

How does Troy Medicare achieve a $0 Customer Acquisition Cost?

According to slide 10, the company leverages a 'free pharmacy distribution channel.' Because seniors visit their community pharmacy an average of 36 times per year and trust their pharmacist more than their primary care doctor, Troy Medicare uses word-of-mouth and pharmacist recommendations to enroll members. This bypasses the 45% of non-medical expenses incumbents typically spend on advertising and the 25% spent on broker commissions.

What are the financial projections for the company?

Slide 9 outlines an aggressive growth trajectory. Starting from $0 revenue in 2019, the company projected $4.5 million in 2020, scaling to $497.3 million by 2026. While they projected losses in 2019 and 2020 due to capital reserve requirements and startup costs, they expected to reach EBITDA profitability in 2021 with 2,085 members enrolled.

Who are the primary competitors identified in the deck?

Slide 5 lists major incumbents: United Healthcare Group ($240B market cap), Humana ($40B market cap), Aetna (purchased by CVS for $69B), Cigna (merged with Express Scripts for $67B), and WellCare (purchased by Centene for $15B). The deck highlights these competitors' reliance on big-box retail partnerships (Walgreens, Walmart, CVS) to contrast with Troy's independent pharmacy focus.

What is the background of the leadership team?

The team is highly specialized. CEO Flaviu Simihaian previously led iMedicare, a SaaS platform used by 6,000+ pharmacies. The team includes a former Deputy US Marshal as Chief Compliance Officer, a former President of an ACO business as Chairman, and a leading Medicare actuary. This mix of software engineering, regulatory compliance, and actuarial science is designed to de-risk the complex insurance model.

Troy Medicare pitch deck: the facts

Company

Troy Medicare

Year

2019

Stage

Series B

Slides

17

Sector

Medicare Advantage / Health Insurance

Deck type

Fundraising

Outcome

$36,600,000 raised

Headquarters

Charlotte, North Carolina

Troy Medicare pitch deck PDF

The full Troy Medicare deck is embedded on this page and can be read slide by slide in the browser — no download or account required. Each slide is covered in the breakdown above.

What the Troy Medicare pitch deck was used for

This is Troy Medicare’s 2019 **Series B** pitch deck (17 slides) for a pharmacy-powered Medicare Advantage plan that uses independent community pharmacies as its primary distribution and care-management channel. The deck positions Troy as combining modern data science with trusted local pharmacies to reduce customer acquisition cost by 20x versus incumbents and to manage chronic disease more effectively. It was used ahead of the company’s $10M Series B round announced in November 2020, led by AXA Venture Partners with participation from Sunwater Capital, to expand its Medicare Advantage plan and invest further in technology and pharmacy partnerships. The company serves Medicare-eligible beneficiaries in select North Carolina counties via a $0 premium, pharmacy-first Medicare Advantage model powered by its Troy.AI platform.

Business model: Pharmacy-powered, technology-driven Medicare Advantage plan that partners with local independent pharmacies to deliver AI/data-driven care management and transparent drug pricing for Medicare-eligible beneficiaries in select North Carolina communities.

Round

Series B

Year

2020

Raised

$10M Series B funding round announced November 17, 2020.

Lead investor

AXA Venture Partners

Investors

AXA Venture Partners, Sunwater Capital

Founders

Flaviu Simihaian

Headquarters

Charlotte, North Carolina, United States.

Industry

Medicare Advantage / Health Insurance.

Total funding: Approximately $15M across two rounds as of Nov 17, 2020, including a $10M Series B; one funding database reports total funding of $15M with two rounds (2019 and 2020).

Use of funds as presented: To expand Troy’s pharmacy-powered Medicare Advantage plan in underserved communities and make significant investments in technology, including the Troy.AI platform and partnerships with local independent pharmacies.

What happened after the Troy Medicare deck

Troy Medicare used its 2019 Series B deck to articulate a pharmacy-first, data-driven Medicare Advantage model and subsequently raised a $10M Series B in November 2020 led by AXA Venture Partners, with Sunwater Capital also participating. The company remains active as of 2026, operating a $0-premium, pharmacy-powered Medicare Advantage plan in select North Carolina communities and continuing to in

• Launch of Troy Medicare as a pharmacy-powered Medicare Advantage plan leveraging independent pharmacies and technology,
• Announcement of a **$10M Series B** funding round on November 17, 2020, led by AXA Venture Partners with participation f
• Continued operation as of 2026 as a Medicare Advantage plan serving select North Carolina counties, with a pharmacy-firs

What the Troy Medicare deck got right

• Unique independent pharmacy distribution and trust advantage. A **pharmacy-first distribution strategy** leveraging 21,000+ independent community pharmacies that seniors visit frequently and trust more than primary care doctors, enabling a free, word-of-mouth acquisition channel and close care-management relationships.
• Structurally lower CAC versus broker- and advertising-heavy incumbents. Claims of a **customer acquisition cost 20x lower than incumbents** and $0 spend on advertising by acquiring members through pharmacies rather than brokers or mass marketing, directly attacking the 70% non-medical spend dominated by advertising and brokers in traditional MA.
• Integrated AI/data platform supporting pharmacy-centered care management. A **data-science and AI-driven care model** (Troy.AI) that uses real-time data analysis, medication management, and proactive member outreach to support pharmacy-centered chronic disease management and improve health outcomes.
• Member- and pharmacy-friendly benefit design with transparent pricing. A differentiated **benefit design** featuring $0 premiums and $0 copays for generics at independent pharmacies, combined with transparent drug pricing and fair reimbursement structures (e.g., NADAC-based pricing, clinical-service payments) aimed at aligning incentives between Troy, pharmacies, and members.
• Focused challenger narrative against large incumbents and retail pharmacy chains. Clear **challenger positioning** against major incumbents (UnitedHealthcare, Humana, Aetna, Cigna, WellCare) and their retail partners (Walgreens, Walmart, CVS, Express Scripts, Centene), framing Troy as focused on underserved communities and local relationships rather than national retail chains.
• Strong institutional investor validation at Series B stage. Demonstrated ability to raise a **$10M Series B led by a global technology-focused VC (AXA Venture Partners)** with participation from Sunwater Capital, validating investor belief in the pharmacy-powered, technology-driven Medicare Advantage thesis.

What could have been stronger

• Limited quantitative detail behind CAC and unit economics. The deck makes aggressive claims about a **customer acquisition cost 20x lower than incumbents and $0 spend on advertising**, but the excerpts do not provide unit economics details (absolute CAC, payback period, LTV/CAC ratio) or independent validation, which investors would need to underwrite the model’s scalability and sustainability.
• Pharmacy network strength is asserted but not evidenced. While the slides emphasize close relationships with **21,000+ independent pharmacies** and pharmacy-powered care management, they do not (in the excerpt) show concrete evidence of pharmacy engagement quality, contract structures, or operational scalability—for example, actual clinical outcomes, adherence improvements, or savings metrics generated by the model.
• Regulatory and risk-management capabilities underexplained. The competitive slide lists large insurers (UnitedHealth, Humana, Aetna, Cigna, WellCare) and their retail pharmacy partners, but the OCR text does not show clear **defensible regulatory, capital, or risk-management capabilities** that are critical in Medicare Advantage (e.g., Star Ratings, CMS audit readiness, risk adjustment expertise), leaving a potential perceived gap versus incumbents.
• Go-to-market and geographic expansion plan not fully articulated. The deck highlights the size of the Medicare Advantage market (projected 40M seniors by 2025 and ~$800B market size), but the provided text does not show **service-area strategy, county-by-county expansion plan, or capital requirements per market**, which would help investors understand how Troy can capture meaningful share given the capital intensity of MA market entry and bidding.

How an investor would read this deck

What draws attention

• Proof that the pharmacy-first distribution model can maintain **low CAC at scale**, with detailed unit economics (CAC, LTV, churn, payback) beyond the early-member proof cited in the deck.
• Strength and durability of **independent pharmacy relationships**, including contractual terms, economic incentives, and any risk of disintermediation by larger PBMs or insurers.
• Regulatory performance and **CMS metrics** (Star Ratings, compliance history, risk-adjustment accuracy) to validate that the data-science and AI claims translate into sustainable Medicare Advantage economics.
• Evidence that the **transparent drug pricing and $0 generics** model is economically viable for both Troy and pharmacies over time, especially given NADAC-based reimbursement commitments.

Risks that stand out

• Dependence on **independent pharmacies** as the core distribution and care channel exposes Troy to concentration and bargaining risks if pharmacies consolidate, face financial stress, or are targeted more aggressively by larger insurers’ own preferred networks.
• Executing a **$0 premium, $0 generics, transparent pricing** promise while maintaining acceptable margins could be challenging if medical costs trend unfavorable or if CMS benchmark rates tighten, particularly in underserved communities with higher risk scores.
• Medicare Advantage is a **highly regulated, capital-intensive business**; any missteps in risk adjustment, compliance, or Star Ratings could materially impact revenue and growth, and the deck excerpts do not yet demonstrate deep risk-management infrastructure.
• Large incumbents with deep marketing budgets and established brand trust (UnitedHealthcare, Humana, Aetna, Cigna) may respond by strengthening their own pharmacy relationships or launching similar transparency features, eroding Troy’s perceived differentiation.

Questions this deck invites

• What are Troy Medicare’s current **membership numbers, growth rate, and retention** since the 2019 deck and 2020 Series B, and how do these compare to the early 250-member milestone mentioned in secondary deck analyses?
• How is Troy’s **Troy.AI platform** technically architected and integrated with pharmacy workflows and claims data, and what measurable impact has it had on clinical outcomes and costs (e.g., adherence rates, hospitalization reduction)?
• What are Troy’s **unit economics by county/plan** (premium PMPM, medical loss ratio, administrative expense ratio, pharmacy reimbursement, CAC, LTV) and how have these trended since launch?
• How many **independent pharmacies** are under active contract, what percentage of their Medicare-eligible customers are Troy members, and what is the churn or satisfaction rate among pharmacies?
• What is Troy’s **regulatory track record** (Star Ratings, CMS audits, any sanctions) and how does its performance compare with local and national competitors in its North Carolina markets?

What founders can take from the Troy Medicare deck

• A highly specific **distribution advantage**—in this case independent pharmacies visited frequently and trusted by seniors—can anchor a compelling Series B narrative when it clearly challenges incumbents’ costly marketing and broker-heavy acquisition models.
• Quantifying the **waste in incumbent cost structures** (e.g., 45% advertising, 25% brokers within non-medical spend) and directly tying it to the startup’s lean alternative model helps investors see both margin opportunity and structural differentiation.
• Positioning a startup as the **only company combining modern data science with a trusted legacy channel** (local pharmacies) illustrates how technology and existing relationships can be combined to create defensible advantages in regulated markets.
• Clearly naming **giant incumbents and their strategic partners** (United with Walgreens, Humana with Walmart, Aetna with CVS, Cigna with Express Scripts, WellCare with Centene) helps contextualize market power while setting up a challenger narrative focused on underserved niches.
• Articulating a **zero-CAC, word-of-mouth growth story** is powerful but must be backed with concrete metrics; Troy’s deck shows how early member acquisition via trusted pharmacies can seed such a story for investors evaluating scalability.
• Anchoring the story in a large, growing **Medicare Advantage TAM** (tens of millions of seniors, hundreds of billions in market size) while focusing on underserved communities demonstrates how a niche entry strategy can still tap into a massive market.

Troy Medicare pitch deck: common questions

What is Troy Medicare and what does it do?

Troy Medicare is a **pharmacy-powered, technology-driven Medicare Advantage plan** based in Charlotte, North Carolina that partners with local independent pharmacies to deliver chronic disease management, transparent drug pricing, and AI-driven care coordination to Medicare-eligible beneficiaries in select North Carolina counties.

How much funding has Troy Medicare raised and who invested?

Troy Medicare announced a **$10M Series B** funding round on November 17, 2020, led by AXA Venture Partners with participation from Sunwater Capital. Funding databases summarize that the company has raised about **$15M across two rounds**, with an earlier raise in 2019 and the Series B in 2020.

What is Troy Medicare’s main pitch in its 2019 Series B deck?

The 2019 Series B deck focuses on leveraging **21,000+ independent community pharmacies** as a free distribution and care-management channel, claiming a **customer acquisition cost (CAC) 20 times lower** than major insurers like UnitedHealthcare, Humana, and Aetna, and $0 spend on advertising due to word-of-mouth through trusted pharmacists. The deck also highlights a data-science-driven benefit design and pharmacy-led care management as key differentiators.

What was the Troy Medicare Series B funding used for?

According to the company’s press release and investor materials, the Series B funding is used to **expand Troy’s Medicare Advantage plan in underserved communities** and to make a “significant investment in technology,” including its AI-powered Troy.AI platform and partnerships with local independent pharmacies.

How is Troy Medicare different from traditional Medicare Advantage plans?

Troy Medicare differentiates itself by offering **$0 premium Medicare Advantage plans** with **$0 copays for generic medications at independent pharmacies**, 100% transparent drug pricing (using NADAC benchmarks), pharmacy-centered chronic disease management, and an AI/data platform (Troy.AI) that drives proactive member outreach and care coordination.

Sources

Funding and outcome facts on this page were researched on 2026-08-21 from the pages below.

• Troy Medicare pitch deck to raise $10m Series-B round
• What's Covered in 2026: A Guide to Troy Medicare's Benefits for...
• Troy Medicare Announces $10M Series B Led by AXA Venture...
• Troy Medicare Expands Proactive Care Management with...
• AXA backs health insurer Troy Medicare
• Troy Medicare | AVP Library
• Flaviu Simihaian - Circle of Health

Troy Medicare pitch deck slides

What each slide of the Troy Medicare pitch deck says

Slide 2

Ivoy Troy Medicare removes the fat in the Medicare healthcare program.

Slide 3

Medicare Market 'foa MEDICARE Medicare is a government program that covers the healthcare of 50 million seniors and continues to expand each year to cover more residents of all ages Medicare Advantage represents the private companies which the US government contracts to administer the Medicare program for 21 million Americans Medicare Advantage is growing at an increasing rate, and will surpass 40 million seniors by 2025 (that's a $800 Billion market size) Weacs

Slide 4

Independent Pharmacies Efog MEDICARE * 21,767 community pharmacies (36% of all pharmacies in the US) are independently owned small businesses, often located in underserved areas where access to care is a challenge * Services include: Immunizations, Medication Reconciliation, Home Delivery/Home Visits, Tobacco Cessation Programs, Nutrition Counseling, and Point of Care Testing + The average senior visits their community pharmacy 3 times per month (36 times per year) and trust their pharmacist more than their primary care doctor

Slide 5

Direct Competitors img' * United Healthcare Group — $240 Billion market cap - closely partnered with Walgreens * Humana — $40 Billion market cap - closely partnered with Walmart + Aetna — purchased by the CVS pharmacy chain for $69 Billion + Cigna — merged with Express Scripts in a deal valued at $67 Billion * WellCare — purchased by Centene for $15 Billion

Slide 6

The Fat [foxd MEDICARE » Advertising/Marketing accounts for 45% of non-medical expenses each year * Insurance Brokers account for 25% of non-medical expenses each year » Pharmacy Benefit Managers (PBMs) - 5% of non-medical expenses + Bloated transactional system with 0 drug pricing transparency + Ineffective at managing drug costs and disconnected from the health costs * Third Party Administrator (TPA) functions - 20% of non-medical expenses * Outdated technology standards make care management impossible « Data delays lead to provider and patient dissatisfaction » Care Management Vendors - 4% of non-medical expenses » Many duplicate vendors with no incentives to integrate and share data

Slide 7

Enter Troy Medicare i\roa MEDIGARE * Troy Medicare is the only Medicare company that combines modern data science techniques with the patient accessibility and trust of local community pharmacies. * Unfair competitive advantage: « Customer Acquisition Cost is 20 times lower than the competition » Close relationships with 21,000+ local community pharmacies in all 50 states » Unique care management that is more effective than current models » Founded by software engineers with a history of disrupting Medicare » Data-driven benefit design proven to attract members

Slide 10

Unfair Distribution im(;} Troy Medicare has an unfair advantage: a customer acquisition cost that is 1/20th compared to United, Humana, and Aetna. By leveraging a free pharmacy distribution channel, Troy Medicare is acquiring customers without being beholden to insurance broker commissions Due to word-of-mouth, Troy Medicare has acquired all members while spending $0 on advertising and marketing. Unlike the relationship with an insurance broker, seniors have a trusted, long-term relationship with their pharmacy. * This leads to a much higher retention and long-term value (LTV) of each member

Slide text above is read directly from the Troy Medicare deck PDF embedded on this page.

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