Blue Shield of California PBM Disrupts Traditional Model

Blue Shield of California PBM is shaking things up in the healthcare industry. This innovative approach is transforming the way pharmacy benefits are managed, and it's a game-changer for patients.

By leveraging data and analytics, Blue Shield of California PBM is able to identify areas of improvement in the traditional pharmacy benefit model. This allows them to make targeted changes to create a more efficient and effective system.

The result is a more streamlined process for patients, with reduced wait times and easier access to medication. This is a significant improvement over the traditional model, where patients often faced lengthy wait times and bureaucratic hurdles.

Blue Shield of California PBM's innovative approach is also leading to cost savings for patients and payers.

On a similar theme: Bcbs Pharmacy Prior Authorization

Blue Shield of California's New PBM Model is a game-changer for the 4.8 million members who will benefit from it. The program is part of Blue Shield's Pharmacy Care Reimagined initiative, which aims to make pharmacy services more affordable and transparent.

Intriguing read: Bcbs Fep Pharmacy Prior Authorization Form

The new model involves partnering with five organizations to provide an integrated, coordinated, and holistic pharmacy experience. This includes Amazon Pharmacy, which will provide free delivery of prescription medications, up-front pricing, and 24/7 access to pharmacists.

Mark Cuban's Cost Plus Drug Company is also on board, working to establish a transparent and more affordable pricing model that reduces surprise drug pricing for consumers. Abarca will pay prescription drug claims and evolve its Darwin technology platform to new, simplified payment models.

Prime Therapeutics will work with Blue Shield to negotiate savings with drug manufacturers, moving towards a value-based model that aligns drug pricing with patient efficacy and health outcomes. CVS Caremark will provide specialty pharmacy services, including education and high-touch patient support for members with complex medical conditions.

This new model is expected to save Blue Shield up to $500 million in annual drug costs once fully implemented. The health plan hopes to fully launch the program in 2025, after a limited rollout next year.

Here's an overview of the new PBM model partners:

Blue Shield of California's Pharmacy Benefit Manager (PBM) is taking a bold approach to pharmacy care by partnering with five companies to create a more transparent and affordable system. This new model is part of the Pharmacy Care Reimagined initiative.

The five partners are Amazon Pharmacy, Mark Cuban Cost Plus Drug Company, Abarca, Prime Therapeutics, and CVS Caremark. Each company has a designated function to help Blue Shield of California achieve its goals.

Amazon Pharmacy will provide free delivery of prescription medications, as well as status updates, up-front pricing, and 24/7 access to pharmacists. This will make it easier for patients to manage their prescriptions and stay on top of their medication.

Mark Cuban Cost Plus Drug Company will work to establish a transparent, more affordable pricing model to reduce surprise drug pricing for consumers at the pharmacy pickup counter.

Abarca will pay prescription drug claims and evolve its Darwin technology platform to new, simplified payment models. This will help streamline the payment process and make it more efficient.

Related reading: Help with Medical Bills Colorado

Prime Therapeutics will work with Blue Shield of California to negotiate savings with drug manufacturers to move toward a value-based model that aligns drug pricing to patient efficacy and health outcomes.

CVS Caremark will provide specialty pharmacy services, including education and high-touch patient support for members with complex medical conditions.

By partnering with these companies, Blue Shield of California aims to save its 4.8 million members as much as $500 million a year in drug costs, or about 10% to 15% of what it spends on drugs annually.

Take a look at this: Will You Be My Something Blue?

The Blue Shield of California PBM has faced several challenges and disruptions in its operations. One of the significant challenges is the increasing complexity of the pharmacy benefit management (PBM) space, which has led to higher costs and decreased transparency.

The company has struggled to navigate the complex web of pharmacy contracts, rebates, and discounts, resulting in higher costs for patients and payers. This has led to increased scrutiny from regulatory bodies and lawmakers.

The company's reliance on a narrow network of pharmacies has also been a point of contention, with some critics arguing that it limits patient choice and drives up costs.

Additional reading: What Is Y Combinator Company

Coordinating so many different parties could prove challenging, and the payer and its partners may struggle to implement new pricing with drugmakers.

The complexity of coordinating with multiple parties is a significant concern, with some analysts suggesting that BSC might be taking on too much.

Drugmakers, PBMs, and payers have overlapping or competing businesses, which could lead to difficulties in implementing new pricing agreements.

This complexity could make it harder for BSC to achieve its goals, and its partners may face significant challenges in implementing new pricing models.

The payer and its partners could struggle to match the discounts negotiated by PBMs, which would be a major obstacle to overcome.

Readers also liked: What Are the Best Places to Elope in California?

The future of healthcare is looking increasingly uncertain, and it's not just because of the pandemic. Unbundling and demystifying prescription prices has long been a goal for many in the health care ecosystem.

Industry insiders are predicting more disruption to come, with a reckoning happening in Congress, state governments, and the commercial sector. This convergence of interests is creating an environment ripe for change.

A recent move by BSC is being seen as a signal that this disruption is already underway. The impact of this shift will be significant, and it's essential to stay informed about the developments.

The health care ecosystem is on the cusp of a major transformation, and it's crucial to understand the forces driving this change. The future of prescription pricing is uncertain, and it's anyone's guess how this will play out.

Readers also liked: How to Contest a Will in California?

Blue Shield of California (BSC) is taking a bold step by transitioning its drug supply management from CVS Health's PBM to five new companies. This move is expected to save BSC's 4.8 million members as much as $500 million a year in drug costs.

BSC is adopting a best-in-breed approach, aligning with the five companies to negotiate prices with drug manufacturers. Each partner has a designated function, and BSC will retain 100% of manufacturer rebates.

The new plan will begin in 2025 and aims to bring substantial savings to BSC members. By retaining rebates and passing savings on to members, BSC is putting its members first.

The transition is a significant overhaul of BSC's pharmacy care model, which was already in development before the controversy over the alternative drug to Zytiga arose.

Suggestion: Vanguard Health Savings Accounts

Blue Shield of California is dividing the work of paying for prescription drugs among five different vendors. This move is a significant shift from relying heavily on CVS Health's pharmacy benefit manager, CVS Caremark.

One of the new vendors is Amazon, which will be playing a role in the company's drug pricing operation. Mark Cuban's pharmacy company is also on board.

In 2024, Blue Shield will rely less on CVS Caremark, a decision that led to a 9% drop in CVS' stock price on Wall Street. This change is part of a broader effort to overhaul the prescription drug system.

See what others are reading: Electronic Prior Authorization Vendors