The issue of rising prescription drug prices is multi-faceted and complex. Solving the problem is equally confounding.
“There’s no silver bullet here,” said Atheer Kaddis, vice president, Pharmacy Services, Blue Cross Blue Shield of Michigan.
According to a recent Blue Cross Blue Shield Association Health of America report, commercially-insured members across the country spent 20 percent of their health care dollars on prescription drugs in 2017, which equates to more than $100 billion.
A panel of experts, including Kaddis, will take up the topic of the cost of prescription drugs at the next Health Forum of West Michigan, which takes place on Friday, Dec. 7. The forum is sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network and provides an opportunity for community conversations around public health to take place every month at Grand Valley State University. Other December panelists include Christina Barrington, vice president, Pharmacy Programs at Priority Health; Eric Roath, clinical care coordinator at Spartan Nash; and Greg Wellman, professor of Pharmacy Administration at Ferris State University College of Pharmacy.
Kaddis will talk specifically about prescription drugs administered by medical professionals, which make up 50 percent of specialty drug costs. These drugs represent exciting advances in medical research, in some cases providing potential cures to diseases, but their promise often comes with a high price tag.
“If it’s medically necessary, patients should have access to these therapies,” Kaddis said.
As a health insurer, BCBSM has been working to reduce the costs of specialty drugs in three main ways:
- Monitoring the emerging therapies pipeline and developing medical policy in a proactive manner. The prescription drug development pipeline is robust and there are currently over 1,600 medications in late-stage clinical development. Some of these medications are gene-based therapies that may cost more than $1 million per patient. Blue Cross is closely tracking these medications in development and proactively developing coverage policies, management strategies, and payment strategies in preparation for these medications becoming commercially available.
- Working with drug manufacturers to secure discounts. Currently, Blue Cross negotiates rebates and discounts with manufacturers by placing drugs on a “preferred” formulary list. Moving forward, Kaddis expects contracts between insurance companies and manufacturers to be based on achieving a measurable clinical outcome, such as reducing the rate of heart attacks by a certain percent. “That way, we are all accountable for the actual outcomes of that drug,” he said.
- Ensuring that specialty drugs are only being used for indicated medical conditions. Drug utilization management programs employ tactics such as requiring prior authorization for prescriptions and placing quantity and duration limits. By following FDA-approved labeling as well as peer-reviewed clinical trials and national treatment guidelines to ensure that medications are being appropriately prescribed, Blue Cross is able to lower spending on prescriptions.
Kaddis said finding a way to balance high costs while still delivering appropriate and necessary medical treatment will continue to be a high priority for Blue Cross.
“It’s critical for us to figure out ways to make these drugs affordable and make sure they’re being used by the appropriate patients,” Kaddis said.
Want to learn more about the issue of prescription drug prices in person? Register to attend the next Health Forum of West Michigan here.
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