Blue Cross Blue Shield of Michigan joined four other Blues plans across the U.S. to form a new venture that seeks to reduce the high cost of prescription drugs.
The newly created Evio Pharmacy Solutions will essentially analyze claims trends to identify how well drugs work for the more than 20 million members of the five Blues plans. The idea is to drive physicians and consumers to use medications that work best for their medical conditions to improve cost and quality.
“It’s really looking at innovations in pharmacy to drive more affordability and quality for our members,” Lynda Rossi, executive vice president for strategy innovation and public affairs for Blue Cross Blue Shield of Michigan, told MiBiz. Rossi is also a board member at Evio. “Pharmacy is by far one of the biggest expenditures for us and is certainly eating into the pockets of our members through their co-pays and their costs.”
Blue Cross Blue Shield of Michigan formed the Denver, Colo.-based Evio with Blue Cross Blue Shield of Massachusetts, Blue Shield of California, Pittsburgh, Pa.-based Highmark Inc., and Independence Blue Cross in Philadelphia.
The Blues plans did not disclose their investments in Evio, but each member invested the same amount.
Evio will “accelerate Blue Cross’ efforts to lower the skyrocketing cost of prescription and specialty drugs affecting our customer groups and members,” Blue Cross Blue Shield of Michigan President and CEO Dan Loepp said in a statement.
“Several years ago, for the first time ever, the combined cost of prescription and specialty drugs for our members outpaced the cost for inpatient hospitalization,” Loepp said. “With the pressure that pharmacy costs are putting on health care affordability, now is the moment to bring new ideas and bold innovations to the forefront of our work to lower those costs.”
In 2020, Blue Cross Blue Shield of Michigan paid nearly $1.3 billion in clams for prescription drugs, according to an annual financial report to state regulators.
Through Evio and outcomes data, the health insurers hope to better educate physicians on the drugs that work best and engage pharmaceutical manufacturers in value-based contracts that are often used with care providers to offer incentives for quality medical outcomes.
“For those that we find are giving us better outcomes, we have the ability to have additional conversations with the manufacturers of those drugs,” Rossi said. “Are there valued-based models that we can go after? Are there ways to put together very specific relationships with the drug manufacturers?”