How Highmark Blue Shield delivers pharmacy value for clients, members
At Highmark, more than a third of our overall health care spend is now allocated to pharmacy costs. And, of that pharmacy-related spend, about half of it is on specialty medications that typically treat chronic, complex health conditions associated with high costs. To best serve our clients and members, we have forged partnerships and launched innovative programs that boost prescription drug affordability and adherence. And we also follow the real-world evidence of how effective a medication is to ensure we're delivering value.
Specialty pharmacy innovation
Highmark is working with a healthcare technology company, Free Market Health, to provide streamlined access to prescription drugs for Highmark members with complex health conditions, from specialty pharmacies equipped to provide high-quality care management.
We're utilizing Free Market Health's platform, which matches specialty medication referrals and pharmacies in real time while balancing the cost and value of care. Patients are benefitting, with a reduction in drug abandonment and a reduction in claims costs for medications, benefiting members and group customers.
We also leverage the Free Market Health platform to incentivize specialty pharmacies serving some of our most medically complex members to administer social determinants of health assessments and identify individuals facing additional challenges. Identified members are referred to a Highmark social worker to address their Social Determinates of Health (SDOH) concerns.
Lowering generic drug costs
We have seen more essential generic outpatient medications become scarce or expensive in recent years, creating barriers to better health. These shortages and price spikes create additional stress and financial strain for consumers. When it became time to develop a national response, Highmark stepped up and has continued to play an important role in CivicaScript, a new non-profit drug company dedicated to bringing quality and affordable outpatient generic medications to market.
Highmark members are saving money on their generic oral oncology medication prescriptions through Highmark's leading role in CivicaScript. Members taking abiraterone acetate, which is used to treat prostate cancer, are saving an average of $90 per month in out-of-pocket expenses for the medication through Highmark's role with CivicaScript and a select specialty pharmacies.
Highmark members, group customers and the plan have collectively saved over $6 million since the lower-cost version of abiraterone acetate first became available in September of 2023.
The portfolio of lower-cost medications available through CivicaScript will continue to expand, with a focus on generic outpatient drugs that treat specialty and other chronic health conditions such as cancer and neurological disorders.
We're also part of an initiative to dramatically lower out-of-pocket costs for insulin with CivicaRx. CivicaRx will manufacture and distribute insulins at significantly lower prices than insulins currently on the market, providing value to both insured and uninsured patients nationwide.
Does the drug work?
We are also working with fellow leading Blue Cross Blue Shield plans to curb rising prescription drug costs by improving transparency in the drug value chain, tracking the clinical and cost-effectiveness of medications, and forming innovative partnerships with manufacturers and other stakeholders.
If people take prescription medication, we want it to be safe and effective. The real-world evidence that we receive on the effectiveness of prescription drugs helps us to ensure that we are providing value to our clients and members.
There's no panacea for rising prescription drug costs, but Highmark will continue to put members and clients first through innovation, partnerships and real-world evidence.
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