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Sandra Clarke on Transforming Health Care Through Key Partnerships

Blue Shield of California invests in pharmacy innovation to drive better health outcomes, equitable access, and lower costs
Sandra Clarke portrait
Sandra Clarke

At Blue Shield of California, we continue to drive value for our members with our ambitious plan to transform a dysfunctional healthcare system into one that’s worthy of our family and friends. As Chief Operating Officer, I know that we can't drive significant systems change and innovation on our own. That's why we're investing in key, strategic partnerships that focus on lowering costs and support our members’ experiences, as well as drive change across the system.

Our pharmacy team, and the Pharmacy Care Reimagined work within it, focus every day on how to reimagine the prescription drug experience. We believe every patient should have safe, affordable, appropriate access to drugs. That means constantly assessing and challenging the status quo to ensure all parts of the system deliver true value.

Investing in partnerships to drive innovation

Blue Shield of California is working on several market-based partnerships. We’re investing in companies that aim to help make prescription drugs more affordable by boosting price transparency and measuring their effectiveness.

Whenever we evaluate an investment or a partnership, it’s important that we consider the benefit to members and the best uses for Blue Shield of California resources. We always expect fair financial returns for these ventures in addition to a tangible impact on the cost and quality of health care. Three of Blue Shield’s key investments include:

CivicaScript. Blue Shield of California led an initiative to launch CivicaScript, a nonprofit drug company dedicated to lowering the price of outpatient medications. Blue Shield joined with more than a dozen other Blue plans in 2020 to invest a total of $55 million in CivicaScript. The aim is to join with manufacturing partners to bring more affordable generic drugs to uncompetitive markets.

Our CivicaScript investment is important because it helps address high abandonment rates, which is when patients stop using their prescribed medications because they were too expensive, or because they were tired of asking their pharmacist to call their physician for less-costly alternate drugs.

In August, CivicaScript launched its first drug—abiraterone acetate—a generic drug used to treat prostate cancer that has spread to other parts of the body. The recommended maximum price for pharmacies of $171 a bottle is about $3,000 per month less than the current drug cost.

Blue Shield also joined with Civica to announce funding to develop and distribute insulins at a significantly lower cost than current medications. Civica plans to set a recommended transparent price to the consumer of no more than $30 per vial.  This is another example of how Blue Shield is working to disrupt the drug market to benefit our members and the entire healthcare system.

Evio Pharmacy Solutions. Blue Shield of California invested last year in Evio Pharmacy Solutions, a startup that uses a data-based approach aimed at controlling drug costs. The company aims to help its investor health plans by improving medication affordability, patient experience, and clinical outcomes. Evio is using evidence and data from real patient experiences to show how individual drugs perform for patients in their own context, across the drug's indications, different patient types, and combinations of other comorbidities. Four other Blue Cross, Blue Shield health plans are also funding Evio.

Our investment in Evio has a real opportunity to change the trajectory of pharmacy costs, improve clinical outcomes, and make it easier for patients to access the medications and treatments they need.

Gemini Health. In 2019, Blue Shield of California funded Gemini Health, a San Francisco Bay Area company that provides real-time patient-specific benefit, formulary, and cost information on prescription drugs to prescribers at multiple points of care, including patient-doctor visits. The goal is to give prescribers useable information about medications and potential lower cost options, so they can discuss clinically appropriate alternatives with their patients. The investment yielded more than $20 million in drug cost savings in the initiative’s first two years.