Congressional hearings on PBM practices don’t seem to be doing much yet to ‘fix’ the multitude of problems with PBMs. And, payers nationally have been desperately searching for solutions that offer a better deal for the health plan as well as the patient.
In a bold move, Blue Shield of California (BSCA) took an unprecedented step in 2023: it announced the end of its partnership with CVS Caremark, its traditional pharmacy benefit manager. Rather than replace CVS with another single PBM, BSCA unveiled a pioneering strategy—partnering with a diverse group of companies, each bringing a specialized business model to the task of managing and delivering pharmacy benefits.
Among these new partners are Amazon Pharmacy, Abarca Health, Mark Cuban Cost Plus Drug Company, and Prime Therapeutics, each chosen for their proven expertise in targeted areas. This collective effort was christened the “Pharmacy Care Reimagined Initiative.” The ambition behind the initiative is nothing short of transformative:… to disrupt the established PBM landscape by allocating responsibilities to companies that excel in distinct, specialized roles. For example, Abarca Health now handles drug claims, while Evio Pharmacy Solutions negotiates outcome-based contracts.
BSCA’s vision is guided by a clear objective—to ultimately save $500 million in Rx spend every year.
But what gives this program its unique edge? They say the answer lies in the power of data and technology. BSCA is leveraging information that extends well beyond standard clinical data supplied by manufacturers. By harnessing real-world evidence and advanced analytics, they empower smarter, more holistic decisions. A specialized partner—an expert company focused on this very task—provides the engine driving these data-driven insights.
This sophisticated system now makes it possible for BSCA to make patient-centered, cost-effective decisions spanning the entire spectrum of benefits. It enables meaningful comparisons between medical and pharmacy courses of care, fostering an integrated approach, benefit-wide strategies that prioritize both cost savings, and better health outcomes for members.
In reimagining the future of pharmacy benefits, Blue Shield of California is charting a course that could inspire the entire industry to think bigger, act bolder, and always put patient needs at the center.
Divide To Conquer. Blue Shield of California Is Spreading Out Its Pharmacy Benefit Management
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