At the start of this year, Florida Blue launched two specialty pharmacy programs aimed at reducing drug costs for members on high-priced therapies.
The programs, dubbed FlexAccess and Advocate+ Pharmacy Match, address affordability from two different angles. FlexAccess works on the member side, stabilizing out-of-pocket costs for specialty medications. Advocate+ Pharmacy Match routes specialty prescriptions through a bidding process among participating pharmacies, with the goal of matching each member with the lowest-cost option.
“This is with a network of pharmacies that have clearly demonstrated high quality care for members,” Scott McClelland, Florida Blue’s vice president of pharmacy, said of the Advocate+ program. “We think this is a unique and innovative model that’s out there.”
The program automatically routes commercial members’ specialty prescriptions to a pharmacy offering a low-cost option. When a physician submits a specialty prescription, it goes to a centralized hub, participating pharmacies are notified and can bid on it, and the lowest-priced pharmacy fills the prescription and serves that member for a year. Mr. McClelland said the initiative is already generating $4 million to $5 million in monthly savings.
FlexAccess connects members with available manufacturer drug savings and automatically applies them toward cost sharing, so members on high-cost specialty therapies don’t have to seek out that assistance on their own. Florida Blue describes the program as designed to improve adherence by reducing out-of-pocket burden and giving members more consistent costs month to month.
Mr. McClelland distinguished it from accumulator adjustment programs, where manufacturer coupons don’t count toward a member’s deductible or out-of-pocket maximum and can leave them exposed to full cost-sharing later in the year.
“This program really is more of a smoothing cost share program, and captures those available dollars from the manufacturer to assist members with their cost shares,” he said, noting that early member response has been positive. Implementation took roughly six months and required coordination between Florida Blue and its PBM, along with member communications development.
Mr. McClelland framed both programs as a response to a specialty drug pipeline that continues to add expensive new therapies. Several Blue Cross Blue Shield plans, along with insurers more broadly, have publicly shared the financial pressures caused by the growing popularity of GLP-1s and other expensive specialty medications in recent years. With pharmacy often being the most frequently used benefit for health plans, finding innovative ways to reduce costs in the space has become particularly consequential for plan stability.
“We have very tough jobs that we take very seriously to try to lower costs, and we’re constantly looking for innovative ways to lower costs for our members,” Mr. McClelland said, “because we know that if members are not adherent to their therapy, it does no one any good, and ultimately it costs everyone more money.”
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