America's Benefit Specialist October 2023

PRODUCT NEWS

channels of technology for transparency and automation which also enables us to accelerate decisions to minimize disruption to our members.”

“The current pharmacy system is extremely expensive, enormously complex, completely opaque, and designed to maximize the profit of participants instead of the quality, convenience and cost-effectiveness for consumers,” said Paul Markovich, president and CEO of Blue Shield of Califor nia. “That is why we are working with like-minded partners to create a completely new, more transparent system that gets the right drugs to the right people at the right time at a substantially lower cost.” In today’s pharmacy supply chain, there can be up to a dozen companies involved in the process from when a drug is made to when a member receives it. Some can add complexity and cost without adding value or providing transparency into the rationale for their pricing. To simpli fy the system and cut unnecessary costs, Blue Shield has selected five companies with like-minded philosophical and technology standards to build a new, innovative model following regulatory approval. Together, Blue Shield will offer an integrated, coordinated, and holistic pharmacy experience to its members. Amazon Pharmacy will provide fast and free delivery of prescription medications, complete with status updates, as well as upfront pricing and 24/7 access to pharmacists. Mark Cuban Cost Plus Drug Company will establish a sim ple, transparent, and more affordable pricing model, reduc ing surprise drug costs at the pharmacy pickup counter. Abarca will pay prescription drug claims quickly and ac curately while continuing to evolve its technology platform, Darwin, to support new, simplified payment models. Prime Therapeutics will work with Blue Shield to nego tiate savings with drug manufacturers to move toward a value-based model that aligns drug prices to patient efficacy and health outcomes. CVS Caremark will provide specialty pharmacy services for members with complex conditions, including education and high-touch patient support.

BLUE SHIELD OF CALIFORNIA UNVEILS MODEL TO TRANSFORM PRESCRIPTION DRUG CARE Blue Shield of California has announced a pharmacy care model that is designed to fix problems in today’s broken prescription drug system. The nonprofit health plan is trans forming how medications are purchased and supplied to its 4.8 million members by selecting organizations that share Blue Shield’s vision for more affordable and transparent phar macy services. The announcement is a major milestone in Blue Shield’s Pharmacy Care Reimagined initiative, which will help provide its members with convenient, transparent access to medi cations while lowering costs. Once Blue Shield’s multi-year strategy is fully implemented, the health plan expects to save up to $500 million in annual drug costs. Most American adults take at least one prescription drug annually, with more than a third of adults taking at least three medications per year. Already a significant cost, total prescription drug spend in the United States is consistently rising. In 2021, the American healthcare system spent more than $600 billion on prescription drugs—about $1,500 per person, per year. The current pharmacy care system rewards some stake holders for selling more drugs at higher costs. Blue Shield is seeking to transform the system into a value-based model that provides members with the medications they need at a more affordable cost.

22 ABS | benefitspecialistmagazine.com