Medicines administered by providers should be affordable

  • Natalie Tate, PharmD, is Vice President of Pharmacy at BlueCross.

We have all used drugs to treat an illness. Many of us take medication on an ongoing basis to help manage a health problem. But for a relatively small number of us, these drugs require a more complicated treatment process than taking a pill.

Supplier-administered specialty drugs are drugs that a doctor or nurse can give to a patient in the office, such as an IV injection or drip. Many of these drugs offer enormous potential, treating conditions that were once thought to be incurable, but traditionally they have been extremely expensive. And the costs of these drugs continue to rise.

For years, BlueCross has worked to reduce the costs of these drugs for our members. In 2022, we’re making these drugs more affordable for even more of them.

Taking a step back, Tennessee companies want to cover these drugs for their employees and have asked BlueCross to help them lower the prices. This is especially true for our “self-funded” employer groups – those who pay for their employees’ health care themselves but use BlueCross networks and services. Based on their feedback, we knew we had to act.

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How patients save money on drugs

In 2019 alone, our customers paid more than $ 1.6 billion for specialty drugs. Drugs administered by providers accounted for more than half of these costs, or more than $ 975 million.

Madeline Morrical, a student at Lipscomb College of Pharmacy, prepares a vaccine for COVID-19 during a mass vaccination event at Valor Collegiate Academy on Saturday April 10, 2021 in Nashville, Tenn.

At BlueCross, we are committed to cost savings. In the last two years of uncertainty, these savings are bigger than ever. And for our members who depend on these drugs, we knew we needed to avoid as much disruption as possible.

Extensive consultations with these customers and our supplier partners followed. We then implemented our Advanced Specialty Benefit Management (ASBM) program on January 1, 2020 for many self-funded groups.

Instead of members paying the healthcare provider who administers their medication, they use our network of specialty pharmacies and pay the pharmacy that sends the medication directly to their provider.

The resulting savings come from our negotiations with the pharmacies in the network. These savings go directly to self-funded groups and their employees, not BlueCross.

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Our program is expanding in 2022

An example that I often share is Opdivo, a drug administered by a supplier used to treat cancer. If a supplier purchases from a wholesaler and invoices BlueCross, the average cost per treatment for a member is $ 3,341. But if a supplier orders from a specialty pharmacy, the average fee for a member is $ 2,971. These savings of $ 370 per treatment make a significant difference for our affected members.

Nathalie Tate

We didn’t want to change the drugs we cover because many change or save lives. And we didn’t want our members to change their place of care because we value the relationships they have with their providers.

We took the concerns of these suppliers to heart and introduced our changes gradually with a six-month transition to make it easier for them and thus allow us to make adjustments based on their feedback. We have heard several misconceptions, such as that we would require members to take care of medications themselves or that specialty pharmacies are not equipped to deliver medication properly. These are not true.

Based on the results we have seen, this benefit maximizes efficiency and savings while ensuring limb comfort and ease during treatment. And so far, our efforts have saved companies an average of 14% on drugs administered by providers.

That is why we are now moving forward, expanding it to even more members. On January 1, 2022, all fully insured business plans, both group and Marketplace, will be eligible.

We believe our program will continue to provide safe and convenient access to these important drugs while saving money for employers and members. And making drugs affordable for all who need them is something no one can argue with.

Natalie Tate, PharmD, is Vice President of Pharmacy at BlueCross.

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