November 4, 2020
Re: “An entrepreneur’s health care enrollment advice to all Tennessee employers | Opinion,” by Dr. Hana Ali, Oct. 29.
If you read Dr. Ali’s guest column, you might feel alarmed about some changes BlueCross has made to how provider-administered specialty drugs are covered for some members.
Unfortunately, instead of simply sharing a dissenting perspective, Dr. Ali chose to spread fear with misleading and untrue statements. We’d like to set the record straight.
First, it is absolutely untrue and irresponsible to say that we “offered a plan that does not provide coverage for life saving infusions.”
As we’ve said many times, we did not change the list of drugs we cover. And we did not require members to get care from different facilities. We asked providers to get drugs from a different source, so Tennessee-based businesses and their employees could pay less.
This program does not result in savings for BlueCross. Employers who fund their own benefits – and the families they cover – get all the savings when they pay lower costs for specialty drugs under our new system. It’s also not true that patients can’t benefit from copay assistance programs.
Dr. Ali also ignored the fact that we offered Tennessee providers two new options that would allow them to continue using their preferred sources for specialty drugs, as long as they agree to match the pricing of the specialty pharmacies in our network. We made these changes in response to process concerns raised by physicians. But perhaps process isn’t their main concern.
To date, we’ve covered nearly 8,500 claims through the new program, from over 1,500 providers. Approximately 63% of those have gone through specialty pharmacies in our network. The remaining 37% are from providers who chose to sign up to buy-and-bill through TransactRx, one of the new options we offered in response to provider feedback.
You can get the facts on our specialty pharmacy program at BCBSTworksforyou.com.