Introduction
Blue Shield of California has recently made waves by forging a new path in the pharmaceutical landscape. A year after announcing its intention to move away from traditional pharmacy benefit management (PBM) relationships, Blue Shield is now implementing its innovative Pharmacy Care Reimagined model. This new approach seeks to leverage multiple partners to drive down prescription drug costs, starting with a significant deal to purchase a biosimilar for Humira, one of the most widely used and expensive drugs on the market.
The Partnership: Blue Shield of California and Fresenius Kabi
Blue Shield of California has partnered with Fresenius Kabi, a global healthcare company that specializes in biosimilars, and Evio Pharmacy Solutions to purchase a biosimilar for Humira, known as adalimumab-aacf. This collaboration marks one of the first significant moves under the new Pharmacy Care Reimagined model.
The deal centers on offering the biosimilar at a transparent net price of $525 per monthly dose. By contrast, Humira’s net price can be as high as $2,100 per dose. Through this partnership, Blue Shield expects to provide significant cost savings to its members while improving medication adherence. The vast price difference offers a substantial reduction in overall healthcare costs.
Humira vs. Biosimilars: The Cost Comparison
Humira, manufactured by AbbVie, is the best-selling drug of all time, primarily prescribed for treating rheumatoid arthritis and other autoimmune conditions. However, its high cost has made it a target for cost reduction initiatives.
Biosimilars, such as adalimumab-aacf from Fresenius Kabi, are designed to provide the same therapeutic benefits as the original drug but at a much lower cost. While Humira’s market price can reach up to $2,100 per dose, the biosimilar is available through Blue Shield’s partnership at just $525 per dose. This dramatic price reduction is expected to significantly impact the healthcare landscape, particularly for patients who rely on Humira for long-term treatment.
Pharmacy Care Reimagined Model
Blue Shield’s Pharmacy Care Reimagined model is a bold departure from traditional pharmacy benefit management structures. Rather than working with a single PBM, the insurer has adopted a modular approach, bringing in multiple partners such as Amazon Pharmacy, Abarca, Mark Cuban Cost Plus Drug Company, Prime Therapeutics, and others.
This strategy aims to increase transparency in drug pricing and ensure that patients and members are more informed about their medication options. By moving away from legacy PBM rules, Blue Shield is creating a system that allows for more flexibility and cost-saving opportunities.
Collaborative Efforts: Pharmacy Partners
In addition to working with Fresenius Kabi and Evio Pharmacy Solutions, Blue Shield has maintained a relationship with CVS’ Caremark for specialty pharmacy needs. However, by adding Amazon Pharmacy, Mark Cuban Cost Plus Drug Company, and others to its network, Blue Shield is diversifying its approach to drug procurement and distribution.
These partnerships are designed to enhance price transparency and provide more competitive pricing options for both patients and healthcare providers. The collaboration between these entities underscores the importance of a flexible, modular model that can adapt to the ever-changing needs of the pharmaceutical industry.
Blue Shield’s Strategy for Medication Adherence
One of the key goals of Blue Shield’s Pharmacy Care Reimagined model is to improve medication adherence among its members. By offering the biosimilar for Humira at a much lower price—$525 compared to $2,100—Blue Shield is making it easier for patients to afford their prescriptions. The insurer expects that by reducing the financial burden, more patients will adhere to their prescribed medication regimens, ultimately improving health outcomes.
In fact, most Blue Shield members who use Fresenius Kabi’s biosimilar will pay $0 out of pocket, further incentivizing adherence and ensuring that cost is not a barrier to receiving necessary treatment.
Synergie Medication Collective: A Key Player
The Synergie Medication Collective, co-founded by several Blue Cross Blue Shield plans, has played a crucial role in Blue Shield’s efforts to reimagine its pharmacy model. The collective is a medication contracting organization that helps negotiate drug prices and secure better deals for insurers and their members.
In collaboration with the Synergie Medication Collective, Blue Shield has been able to carve out rebate aggregation from its relationship with Caremark, allowing for even greater savings and price transparency in its pharmacy services.
FAQs
1. What is the Pharmacy Care Reimagined model?
A. The Pharmacy Care Reimagined model is Blue Shield of California’s innovative approach to pharmacy benefit management. It moves away from traditional models and adopts a modular system involving multiple partners to improve cost transparency and reduce drug prices.
2. How much does the Humira biosimilar cost through Blue Shield?
A. The biosimilar for Humira, adalimumab-aacf, is available at a transparent net price of $525 per monthly dose through Blue Shield’s partnership with Fresenius Kabi and Evio Pharmacy Solutions.
3. What are the benefits of using a biosimilar over Humira?
A. Biosimilars offer the same therapeutic benefits as the original drug but at a significantly lower cost. For example, the Humira biosimilar costs $525 per dose compared to Humira’s $2,100 per dose.
4. Will Blue Shield members have out-of-pocket costs for the biosimilar?
A. Most Blue Shield members will have $0 out-of-pocket costs for the biosimilar, making it easier for patients to access the treatment they need without financial strain.
5. Who are the key partners in Blue Shield’s Pharmacy Care Reimagined model?
A. Key partners in the Pharmacy Care Reimagined model include Fresenius Kabi, Evio Pharmacy Solutions, Amazon Pharmacy, Abarca, Mark Cuban Cost Plus Drug Company, Prime Therapeutics, and others.
Conclusion
Blue Shield of California’s move to purchase a biosimilar for Humira directly from the manufacturer marks a pivotal step in its Pharmacy Care Reimagined model. By partnering with Fresenius Kabi and Evio Pharmacy Solutions, Blue Shield is driving down prescription drug costs and improving access to life-saving medications for its members. This innovative approach is set to transform the pharmaceutical industry, making medication more affordable and improving transparency in drug pricing. As Blue Shield continues to develop its modular pharmacy model, patients and providers alike stand to benefit from increased flexibility, lower costs, and better healthcare outcomes.
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