Carve-in pharmacy can reduce costs

Managing prescription drug costs: Integrated Rx leads multi-pronged approach

We previously reported on our efforts to control premium costs in Rhode Island, proposing a three-way partnership among providers, patients, and insurers. Now we take a look at how we can address a significant driver of rising healthcare costs: prescription drugs.

The cost of prescription drugs is rising at an alarming rate. During just one 12-month period (mid-2015 to mid-2016), drug prices nationally increased by an average of nearly 10%.1 A number of interrelated factors contribute to this, including the high cost of brand-name and specialty medications. While brand-name drugs account for only 10% of all prescriptions written in the U.S., they make up 72% of prescription drug spending.2 Some commentators predict that brand-name drug costs will continue to rise at an average annual rate of 25%, which means that consumers will ultimately pay more for their healthcare.3

What BCBSRI is doing: a multi-pronged approach

Offering health plans that integrate pharmacy and medical benefits has been shown to reduce costs and improve care.

A recent study from Prime Therapeutics, our pharmacy benefits manager, found that integrating these benefits resulted in 11% lower annual member medical costs, 9% fewer inpatient hospital stays and 4% fewer visits to the emergency room.4

Unlike a “carve-out” situation, where pharmacy benefits are managed separately from the medical plan, our integrated model relies on fully coordinated prescription drug and medical claims. With these functions working together, the results are clear: better health outcomes for your employees and a lower overall cost of care.

Partnering with Prime to better manage costs for our members.

Promoting generic utilization.

Prime offers drug management tools focused on using generics, which usually have significantly lower out-of-pocket costs compared to their brand-name equivalents.

Collaborating with primary care providers (PCPs) to bring pharmacists into their offices to improve the patient experience.

Our in-office pharmacists, along with the member’s PCP, work to ensure members understand the medications they need and the importance of taking them regularly and suggest more affordable generic substitutions when appropriate. They also monitor patients’ prescriptions to avoid potentially harmful drug interactions that could lead to emergency room visits or hospital stays.

New reimbursement models focused on drug effectiveness and outcomes.

Just as we have introduced reimbursement models that pay providers based on patient outcomes rather than the number of services provided, we are introducing models that tie pharmacy reimbursement to the effectiveness of drugs prescribed. This practice could have significant impact over time on lowering costs by reducing unnecessary or ineffective prescriptions.

What’s ahead?

There are no easy solutions to addressing the rising costs of prescription drugs, but progress can and is being made as we look at innovative and collaborative ways to tackle this critical issue on several fronts. BCBSRI will continue to work with providers, employers, and our members to find ways to drive down prescription drug costs.

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1"7 common expenses growing much faster than inflation," Selena Maranjian, USA TODAY, July 29, 2017

2"Prescription drug prices jumped more than 10 percent in 2015, analysis finds," Brady Dennis, Washington Post, January 11, 2016

3"Pricey Brand-Name Drugs Drive Prescription Costs, Survey Finds," Maggie Fox, May 3 2017

4“Five Carve-In Pharmacy Benefits Drive Cost Savings: Results of a National BCBSA Study,” Blue Cross Blue Shield Association, December 2013