BCBST News Center: BlueCross responds to misleading claims by coalition of state rheumatology organizations about our specialty pharmacy program

Response to Misleading Claims by the Coalition of State Rheumatology Organizations about our Specialty Pharmacy Program

BCBST News Center
Jan 31, 2020

In a press release issued Jan. 29, CSRO appears to be intentionally spreading misinformation and fear, as evidenced by their claim that physicians will no longer be able to infuse patients in their office.

Our program does not require a change in the site of care for members. If that occurs, providers are forcing that choice on their patients. Our program also continues to pay providers to administer the same drugs, as before, but changes the source for the drug being shipped to providers’ offices.

Further, there is no evidence to support the CSRO assertion that physicians are bringing down the cost of provider administered drugs. In fact, the cost of specialty drugs, which account for 1 percent of utilization and around 50 percent of total prescribed drug costs, is rising almost 10 percent annually. There are more specialty drugs than ever before and more are in the pipeline.

The CSRO also contends pharmacy benefit managers choose higher-priced drugs to make more money. That’s also false. We maintain contracts directly with our in-network specialty pharmacies to control the reimbursement levels for these drugs. We contract with a third-party administrator responsible for processing and paying prescription drug claims only. However, any savings generated from our program go directly to Tennessee-based employers and our members, not to BlueCross or our pharmacy benefit manager.

Our group customers asked us to help address this unsustainable trend. And we’ve asked providers to join us to help save these groups’ and our members’ dollars.

For more information on our specialty pharmacy program, visit BCBSTworksforyou.com.