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Blue Shield of California Invests in Innovation to Address the Price of Prescription Drugs for Members

As the latest addition to its ongoing efforts to address the skyrocketing costs of prescription drugs, Blue Shield of California became one of five not-for-profit Blue Cross and Blue Shield plans to invest in new venture Evio Pharmacy Solutions. The company, based in Denver, Colo., was founded to create value for its investor health plans and the members they serve by improving medication affordability, patient experience, and clinical outcomes. Core focus areas include:

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  • Using data analytics and real patient experiences to understand how drugs perform in a variety of real-world scenarios, and ensure the right medication gets to every patient, where, when, and how they need it.
  • Leveraging solutions at scale to help get innovations to more patients and integrate with the existing solutions offered by health plans.
  • Continuing the evolution toward value-based care and enhancing outcomes-based contracting in the pharmacy space, especially on high-cost drugs.

“In too many situations today, patients are having to make choices between life-saving drugs and paying for other essential expenses,” said Alison Lum, PharmD, vice president of Pharmacy Services at Blue Shield of California. “This trend runs counter to our vision of a health care system that is worthy of our family and friends, and sustainably affordable. That’s why we’re taking a multi-pronged approach to reimagine pharmacy care for our members.” 

Blue Shield has been working on this issue for years from a variety of angles, by investing in innovative collaborations to improve access to affordable medications and by advocating for sound health policies on behalf of its 4.4 million members.  

Saving patients on their pharmacy costs with Gemini Health

Blue Shield recently provided an update on its ongoing collaboration with San Francisco Bay Area-based technology company Gemini Health. The effort started in 2019 to empower prescribers with real-time information about medications and available lower cost options so that they can discuss with their patients and collaborate to reduce drug costs.

So far, this work has resulted in $20 million dollars in cost savings, a network of 77,000 prescribers with access to the service, and expanded access to pharmacists. Experience with the most recent addition to the suite of Gemini Health technology offerings -- the Drug Savings Reports -- has shown prescribers that up to 40% of a patient’s existing medications have a lower cost equivalent alternative.

Using technology to increase drug price transparency for providers and patients leads to better decision making and can help improve quality and enhance patient experience while reducing costs for members and empowering providers to advocate for their patients.

Increasing the supply of affordable generic medications with CivicaScript

CivicaScript (a subsidiary of nonprofit Civica Rx focused on outpatient medications) is another collaborative initiative funded in part by a group of health plans. In early 2020, Blue Shield embarked on a $55 million dollar effort to invest in nonprofit company CivicaScript with the goal of bringing lower-cost, generic medications to individuals and families.

CivicaScript aims to develop Abbreviated New Drug Applications (ANDAs) for select generic drugs and join with manufacturing partners to bring more affordable generic drugs to uncompetitive markets. Several generic medications have already been identified as having high potential for savings and enhanced competition for other generic drugs.

This first-of-its-kind collaboration was developed to bring effective, affordable prescription medications for members at scale. We expect to see these alternative medications become available as early as 2022.

Bringing down prescription drug prices through health care policy advocacy

In accordance with our company value “Stand for what’s right,” Blue Shield has advocated for legislation that can improve health care quality and reduce costs for communities across California, particularly when it comes to drug cost.

In 2017, Blue Shield championed California’s Senate Bill 17, one of the nation’s first drug-pricing transparency laws. The new law requires drug manufacturers to inform purchasers in advance of any excessive price increase with an explanation as to why the increase was made. This law served as a model for several other states, which have now also enacted their own drug price transparency legislation.

And in 2019, Blue Shield spoke out in strong support of H.R. 3, a federal bill that could potentially lower the cost of drugs used to treat critical chronic conditions like rheumatoid arthritis and diabetes, which are among the highest drug costs that Americans face, year after year.

Blue Shield of California is striving to create a heath care system that is worthy of our families and friends and sustainably affordable. These pharmacy innovations are an important part of our overall approach to reimagine health care for all Californians. We will continue our bold efforts to reduce costs, improve patient experience, and enhance clinical quality while supporting our members, providers, and the communities we serve.