Our solution is to require providers to order specialty medications from a pharmacy in our specialty network.
Dec. 23, 2019
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.
Our customers are asking us to do more to help them manage these costs. Our solution is to require providers to order specialty medications from a pharmacy in our specialty network.
Pilot program begins Jan. 1
Our pilot program will roll out Jan. 1, 2020, with many of our self-funded employer group customers who have opted in. These groups pay for their employees’ health care themselves but use BlueCross BlueShield networks and services. At any given time, about 1% of their employees receive provider-administered specialty drugs and will be affected by this Jan. 1 change.
An example of a provider-administered specialty medication is Remicade, which can be used for certain autoimmune conditions like rheumatoid arthritis. More than 2,000 of our members used this drug in 2018, and treatment plans can range from six to 12 infusions each year. Under our specialty pharmacy network, the cost of an average infusion is $2,000 less than the current reimbursement.
We’re not asking members to change where they get care, or requiring specialty drugs be sent to their homes. Our goal is to minimize changes for our members. Rather, we’re asking providers to help members save money by obtaining specialty drugs in a different way.