Payers are implementing new programs to curb spending on prescription drugs, particularly specialty drugs. These medicines, prescribed to a small number of patients, accounted for half of prescription drugs costs in 2021, per HHS.
Here are five payer initiatives to manage drug costs Becker's has reported since October.
- Independence Blue Cross launched a network to manage the cost and outcomes of gene-based therapies with Philadelphia-based Penn Medicine and Children's Hospital of Philadelphia. Gene-based therapies can treat rare genetic conditions but come with sky-high price tags.
- UnitedHealth Group's pharmacy services company launched a new tool for its members to compare generic drugs' direct-to-consumer prices. The tool, Price Edge, acts like the price matching policy some retailers, including Target and Best Buy, have adopted.
- A partnership between Blue Cross and Blue Shield of Alabama and Magellan Rx Management for utilization management led to $19.2 million in savings from January 2021 to March 2022. Enhanced utilization management programs for specialty drugs can ensure appropriate diagnostic and treatment decision-making through case management and second opinions, clinical leaders for the organizations said.
- Several Blue Cross Blue Shield companies formed a medication contracting organization, Synergie Medication Collective, aimed at reducing high specialty drug costs. The company is focused on reducing costs for medical benefit drugs, which are administered in clinical settings rather than retail pharmacies.
- Through a comprehensive strategy, Regence has achieved a 95 percent adoption rate of biosimilars among its 3.4 million members. The parent company of the BCBS affiliates in Idaho, Oregon, Utah and Washington says it leads the nation in adoption rates for the alternative to biologics, which can cost 15 to 30 percent more than biosimilars.