In 2019, we asked health care providers to join with us to address one rapidly growing cost driver: provider-administered specialty drugs. Our specialty pharmacy program began Jan. 1, 2020, and included self-funded employer group plans. These are plans where the employer is responsible for funding claims and all plan-related expenses but uses BlueCross for administration and added-value services like care coordination. These groups are typically larger companies with 500-plus employees.
What is changing?
On Jan. 1, 2022, we’re expanding our Advanced Specialty Benefit Management (ASBM) program to include more employer-based plans, as well as our Individual/Marketplace plans. This change has proved effective for our large employer groups. Our ASBM program takes advantage of lower pricing that’s already available from our preferred specialty pharmacy network, saving our members money without disrupting their care.
How this change helps our members
Previously, providers could order these drugs from a wholesale distributor. As part of the authorization process for the ASBM program, a preferred specialty pharmacy will ship all provider-administered specialty drugs directly to the provider within 24 hours of order. Members will pay the pharmacy before the drug is shipped instead of paying the provider at the time of the service. This takes advantage of the lower drug prices we’ve negotiated with in-network specialty pharmacies.
In-network providers have other options, including joining our specialty pharmacy network or using TransactRx. Those options allow providers to continue purchasing the specialty medications from a wholesaler and bill us for them through a web-based portal, but at prices consistent with our in-network specialty pharmacies. This has allowed those providers to maintain current operational practices and still pass the savings to our members.
What does this impact?
This program affects only specialty drugs administered in a provider’s office or facility, not self-administered specialty drugs delivered to members’ homes.
If you’re a member with an open authorization for any of the provider-administered specialty drugs, we’ve already reached out to you directly.
- Around Nov. 1, we sent a letter alerting impacted members about this change and how it will affect them.
We’re here for you
If you have questions or need more information about this change, please contact your BlueCross Account Executive.