Drug costs continue to rise — one of the many challenges we face in trying to keep health care costs affordable. One in four people taking prescription drugs reports difficulty affording his or her medication and don’t take the medications as prescribed. Here are some ways that Blue Cross and Blue Care Network are working to control drug costs: •Monitoring emerging therapies and developing medical policy that addresses them. The prescription drug development pipeline is robust, and there are currently more than 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 and developing coverage policies, management strategies and payment strategies before these medications become commercially available. Our goal isn’t to limit access to these medications but to ensure that the medications are prescribed according to labeling approved by the U.S. Food and Drug Administration to benefit patients that need them most. •Maximizing a low net cost approach. Currently, Blue Cross negotiates rebates and discounts with manufacturers by placing drugs on a preferred formulary list and managing utilization of specific drugs. •Working with our pharmacy benefit manager, Express Scripts, and our preferred specialty pharmacy, AllianceRx Walgreens Prime, to achieve top-tier pricing and secure best-in-class discounts. •Supporting our Value Partnerships programs. Working with physician organizations to identify specific ways to reduce overall drug costs while maintaining access to needed medication treatment and quality care. •Coordinating efforts with our care management programs and behavioral health initiatives. We’re working to more effectively coordinate pharmacy, care management and behavioral health interventions to enhance the continuum of care for our members. We take aggressive, appropriate action to eliminate any unnecessary spending when less expensive, clinically equivalent options are available. So, when a pharmaceutical company announces price increases — or releases a new high-priced drug — we already have processes in place to evaluate our drug offerings and provide our members with access to the most cost-effective drug therapy. Making prescription drugs more affordable has never been more important — and we’ve never had more solutions available to help make medicines more affordable and accessible. Our efforts can lead to better clinical outcomes, the ultimate measure of the work we do. You may also like:
Photo credit: Blue Cross Blue Shield of Michigan About the author: Atheer Kaddis is vice president, Pharmacy Services at Blue Cross Blue Shield of Michigan.