News Updates

Article on BCBST News Center (June 23, 2020)

Responding to Continued Misleading Claims by the Coalition of State Rheumatology Organizations

BCBST News Center

 

In a pair of recent press releases, the Coalition of State Rheumatology Organizations (CSRO) continued to incite fear in patients as it attempts to fight our specialty pharmacy changes.

Our program, which went into effect Jan. 1, 2020, requires providers to obtain specialty drugs from one of our in-network specialty pharmacies. We have not changed the list of provider-administered specialty drugs we cover. We are still paying providers for their services to administer these drugs. And we have not asked our members to change where they seek care.

To read the full article, please click here.


Article on BCBST News Center (May 28, 2020)

Moving forward with flexibility: Q&A on our specialty pharmacy changes

BCBST News Center
John Hawbaker

 

Some of our largest customers – Tennessee employers with more than 100 employees – have been asking for help managing the high and rising costs of specialty drugs. BlueCross and these businesses paid $975 million last year for a subset of specialty drugs: the kind administered by a provider.

We asked providers to help by getting these drugs from a specialty pharmacy in our network, which can save employer group customers up to 20%. All of these specialty pharmacies are equipped to safely deliver medications anywhere in the country within 24 hours.

To read the full article, please click here


Article on BCBST News Center (Feb. 13, 2020)

Setting the Record Straight about our Specialty Drug Program

BCBST News Center

 

Specialty drugs account for about 1% of prescriptions covered by BlueCross, but account for about 50% of our total drug costs. Tennessee employers have been asking us to help better manage these costs. Our solution was to roll out a new way for health care providers to order specialty drugs they administer for some of our members – and we stand by it.

This new program saves these employers and our members money while covering the same drugs administered by the same doctors at the same facilities.

We’ve allowed providers to buy these drugs from wholesalers and bill us for them (with a markup). That’s no longer cost-effective for the people we serve. We’re asking providers to buy from qualified, in-network specialty pharmacies instead. That’s because as the state’s largest health plan, we’ve negotiated lower prices with those pharmacies.

To read the full article, please click here


Article on BCBST News Center (Jan. 31, 2020)

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

BCBST News Center

 

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.

To read the full article, please click here


Article on Chattanooga Times Free Press (Jan. 21, 2020)

BlueCross BlueShield of Tennessee defends new specialty drug policy as some legislators cry foul

Chattanooga Times Free Press
Elizabeth Fite

 

Providers and state legislators continue to clash with BlueCross BlueShield of Tennessee over the insurer’s plan to lower costs for some self-funded employer groups by targeting provider-administered specialty drugs — the most expensive of all pharmaceuticals.

Traditionally, providers buy these infusion or injection drugs directly from a wholesaler, then bill the insurer and the patient for the cost of the medication plus a small mark-up to cover their overhead. But BlueCross’ new plan stops reimbursing providers for those drugs for some of its members and instead requires them to be obtained through a specialty pharmacy in the insurer’s preferred network.

To read the full article, please click here


Article on BCBST News Center (Jan. 8, 2020)

7 key facts about our specialty pharmacy changes

BCBST News Center
Natalie Tate

 

You may have heard about changes we’re making about how we cover specialty medications that are administered by health care providers. It’s a complicated topic, and we want to help make sure you understand a few important points.

Here are seven things you need to know about our specialty pharmacy program.

To read the full article, please click here


Article on Chattanooga Times Free Press (Dec. 28, 2019)

Some doctors say BlueCross BlueShield’s new policy harms patients who need specialty drugs

Chattanooga Times Free Press
Elizabeth Fite

 

Some providers who infuse specialty drugs say a new policy from Tennessee’s largest health insurance company could cause them to end the service, threatening their practice and forcing patients to find a new place to receive their life-changing drug infusions.

Starting Jan. 1, BlueCross BlueShield of Tennessee will stop reimbursing providers for certain specialty drugs typically administered in a doctor’s office or hospital setting. These expensive medications are used to treat conditions ranging from autoimmune disorders — such as rheumatoid arthritis, Crohn’s disease and ulcerative colitis — to some types of cancer and eye conditions. The change doesn’t affect drugs patients inject or take on their own.

To read the full article, please click here. 


Article on BCBST News Center (Dec. 27, 2019)

How we’re working to make specialty pharmaceuticals more affordable

BCBST News Center
Henry Smith

 

For patients with potential life-threatening illness, specialty drugs administered by their physicians often allow them to enjoy a quality of life they might not otherwise have.

While these medications show how far medical science has come — there are more provider-administered specialty drugs in development than any other kind of drug — BlueCross and the Tennessee-based employers we serve paid $900 million for provider-administered specialty drugs in 2018.

Specialty drugs account for about 1% of prescriptions covered by BlueCross, but account for about 50% of our total drug spend — and that number is growing rapidly. Further, a large number of specialty drugs are in the pipeline to gain approval over the next few years.

To read the full article, please click here


Article on The Tennessean (Dec. 23, 2019)

BlueCross BlueShield aims to make specialty pharmaceuticals more affordable | Opinion

The Tennessean
Henry Smith

 

Our solution is to require providers to order specialty medications from a pharmacy in our specialty network.

For patients with potential life-threatening illness, specialty drugs administered by their physicians often allow them to enjoy a quality of life they might not otherwise have.

While these medications show how far medical science has come — there are more provider-administered specialty drugs in development than any other kind of drug — BlueCross BlueShield and the Tennessee-based employers we serve paid $900 million for provider-administered specialty drugs in 2018.

Though these drugs are used by only a small number of patients, all insured people help shoulder the cost — and that cost is becoming unsustainable. Specialty drugs account for about 1% of prescriptions covered by BlueCross BlueShield but account for about 50% of our total drug spending — and that number is growing rapidly. Furthermore, a large number of specialty drugs are in the pipeline to gain approval over the next few years.

To read the full article, please click here


Article on The Tennessean (Dec. 22, 2019)

Blue Cross is changing how it covers specialty drugs, so some doctors may not offer them anymore

The Tennessean
Brett Kelman

 

A standoff between Tennessee doctors and the largest insurance company in the state could force some patients to search for a new source for expensive, specialty medications in 2020.

The impact should be limited to customers of BlueCross BlueShield of Tennessee who are on self-funded insurance plans and receive provider-administrated medications, like injections or infusions given in a clinical setting. Pills or liquids that patients take outside of the presence of a medical provider should not be affected.

To read the full article, please click here


BlueCross Is Asking Providers To Help Us Save Our Members Money

We’re focused on the health of our members, but we also have a responsibility to be good stewards of their health care dollars. Now, we’re asking health care providers to join with us to address one rapidly growing cost driver: provider-administered specialty drugs. But some are choosing not to.

We’re working with self-funded employer groups to change the process for how some members pay for specialty drugs they receive at a health care facility.

  • We’re not asking members to change where they get care. We’re asking providers to obtain the drugs in a different, more cost-effective way.

  • We’re still paying providers for their services to administer these drugs.

  • Our new process is similar to how providers serve members of other health plans.

 

Why we’re making this change

There are two ways providers can get these specialty drugs.

  1. Buy them from a wholesaler, then bill BlueCross and the patient.

  2. Order them from a specialty pharmacy in our network, who will bill BlueCross and the patient.

 

We’ve allowed providers to use either method. Many of them choose to “buy and bill,” typically adding a large markup to the drug price. (We’re still paying them for the service of administering the drug.) These drugs weren’t always as expensive – or as common – as they are today, so allowing providers to “buy and bill” wasn’t as big an issue. The change, simply put, helps us keep prices lower because our specialty pharmacies have agreed to much more competitive pricing.

However, BlueCross and the Tennessee-based employers we serve spent $900 million on provider-administered drugs in 2018. There are more of these medications in development than any other kind of drug, and their costs are rising most rapidly.

 

BlueCross and providers have a shared responsibility to help members get these drugs at the best possible price. That’s why we’re beginning to require providers to obtain them from our specialty pharmacy network.

 

This change begins Jan. 1, 2020, for some members (including some with self-funded employer coverage) but will eventually change for all the members we serve.

 

Why some providers are upset about the change

Some providers don’t like this new process because it takes away their ability to add markups to drug costs. But the change, simply put, helps us keep prices lower because our in-network specialty pharmacies have agreed to much more competitive pricing. As prescription drug costs have continued to rise, the Tennessee-based businesses we serve (and our members) have asked us to help manage the costs.

 

We’re still paying providers to serve patients by administering the drugs. And having the drugs shipped from a specialty pharmacy isn’t a disruption compared to having them shipped from a wholesaler. Our in-network specialty pharmacies can deliver within 24 hours.

 

To help with the administrative process, we’ve created a six month transition period and more options for providers to participate in this program. Providers have until June 30, 2020 to fully transition member care to this new program. In addition, we’ve added opportunities for providers to participate in our specialty pharmacy network.

 

Here’s the letter we sent to providers to explain the change.

How this change helps our members – and Tennessee employers

 

If the drug is less expensive through our specialty network (and it usually will be), members will save on their share of the costs. Members will pay the specialty pharmacy instead of their health care provider, typically a few days earlier than they do today.

 

Here’s the letter we sent to members affected by the change.

 

We’re rolling out this change first with some “self-funded groups,” which are organizations that pay for their employees’ health care themselves, but use BlueCross networks and services. Ultimately, these groups, as well as the members covered under their plans, are the ones who’ve been paying large markups. Any savings will go directly to Tennessee employee groups and their employees (our members).

How members will save money

 

We’ll use the specialty drug Remicade as an example.

 

Remicade, which can be used for certain auto-immune conditions like rheumatoid arthritis, is typically administered every 8 weeks (6-7 times per year). Under the specialty pharmacy program, the annual member savings would be between $2,400 and $2,800.

Does this affect me?

 

If you’re currently being treated with one of these drugs – and your plan includes this new benefit – we’ve already reached out to you directly with a letter or phone call. This change applies to all provider-administered specialty drugs on the list and (see the list) for members with certain kinds of coverage. If you do not have a prescription for these types of drugs, this will have no impact on your day-to-day prescriptions.

 

We’re here for you

 

If you use specialty drugs and have any questions about this change and how it may affect your care, we’re here to help. Just give us a call at the Member Service number listed on the back of your BlueCross Member ID card.