Step 2 of 4 · 2019–22

Prescriptions first, payers after

Hinge's buyer committed before any patient showed up. It sold mainly to US self-insured employers and health plans, through its own sales force and through brokers, consultants and other partners, and employers such as Target and Morgan Stanley covered the cost for their employees PEARX-5 PEARX-7 PEARX-8. CEO Daniel Perez said in 2020 that an enterprise makes the purchase and each patient then decides whether to engage PEARX-8. By February 2020 its enterprise book had tripled in six months to 200 implementations, with 100% customer retention by Perez's account PEARX-8.

Pear's route ran through prescribers. In 2021 more than 550 providers wrote more than 14,000 prescriptions, and about 51% of them led a patient to start treatment PEARX-1. Reimbursed revenue was booked only when a prescription was filled PE1. Most of the money came through Access Agreements with state and local governments, providers and payors, which bought prescriptions at volume discounts, were invoiced at the start or at set intervals, and produced revenue when Pear made the products available PE1. The Stanford case describes most revenue as state Medicaid contracts for reSET and reSET-O PE3. In 2021 a state government, a state department and a state agency made up 34%, 23% and 10% of revenue, and in 2022 Access Agreements again produced the majority, lifting product revenue to $10.4 million from $3.7 million PE1.

These contracts resembled Hinge's buyer that commits first, with differences the 10-K spelled out. Each took a lengthy contracting process and was a large share of a quarter's revenue, so one delay could swing results, and they tended to be funded by government money, including grants and opioid settlement funds a state could spend elsewhere PE1. The employers and health plans the 10-K listed among the payers it hoped to win were not among its largest customers PE1.

Rivals Hinge Health reached 200 enterprise implementations with 100% customer retention by February 2020 and raised money at a $6.2 billion valuation in October 2021 PEARX-8 PEARX-7.

Top-Down SellingChannel Partners

Step 3 of 4 · 2021–23

Payment on 41% of filled prescriptions

Hinge then let health plans and other partners carry it into more companies. It worked through clients' health plans, PBMs and administrators to simplify contracting and billing, and a substantial share of its client relationships were contracted through a limited number of health plans and other partners PEARX-5. Many contracts paid on milestones instead of a flat annual fee, members paid nothing, and most clients were offered performance guarantees tied to engagement, reported outcomes or return on investment PEARX-5. By 2023 it had 1,657 clients and 370,526 members, and revenue of $292.7 million PEARX-5.

Pear won reimbursement one coverage decision at a time. It had 39 payors providing access, covered reSET and reSET-O under pharmacy benefits, medical benefits or direct purchase, and disclosed that Medicare had no benefit category for its products PE1. In insomnia, Big Health sold its program directly to health plans and employers and worked to get it into employer benefits packages PE3. Pear's 2022 funnel counted more than 45,000 total prescriptions, a figure that included prescriptions imputed from Access Agreement revenue, with a 53% fulfillment rate and payment on 41% of fulfilled prescriptions, so about 22% of total prescriptions were paid PE1. McCann's view at the bankruptcy: "Payors have the ability to deny payment for therapies that are clinically necessary, effective, and cost-saving" PE3.

Rivals Hinge Health billed many clients on milestones with performance guarantees on engagement, and by 2023 had 1,657 clients and $292.7 million of revenue PEARX-5.

Distribution PartnershipsUsage-Based Pricing

Step 4 of 4 · 2022–23

Bankrupt and sold in pieces

Hinge kept adding clients and selling more to the ones it had. In 2024 clients rose to 2,256, members to 532,326 and revenue to $390.4 million, and at year end it had 50 health plan partners, about 20 million contracted lives and net dollar retention of 117% PEARX-5 PEARX-4. It listed on the NYSE in May 2025 at $32 a share, and in the second quarter of 2026 it had 2,929 clients, an 86% GAAP gross margin and $40.4 million of operating income PEARX-4 PEARX-6.

Pear ran out of money first. It had gone public in December 2021 by merging with Thimble Point Acquisition Corp., a SPAC PE1. In 2022 it reported $12.7 million of revenue against $48 million of research expenses, $79.6 million of SG&A and a $123.4 million operating loss, so SG&A alone ran more than six times revenue, and it cut staff in July and again in November PE3 PEARX-3. On April 7, 2023 it filed for Chapter 11 and terminated about 170 employees, 92% of its full-time staff PE2. In May the assets sold at auction for $6.05 million to four bidders: Nox Health paid $3.9 million for Somryst, and Harvest Bio paid $2.03 million for reSET, reSET-O, the pipeline and the corporate trademarks PE5. McCann wrote that this was "certainly not the outcome I envisioned when I founded Pear in 2013" PE5.

Rivals Hinge Health reported $212.8 million of revenue in the second quarter of 2026 and had an $8.45 billion market value in October 2026 PEARX-6 PEARX-9.

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