Blue Shield of California ‘Reimagines’ Pharmacy Benefit Management

Blue Shield of California has announced a new pharmacy care model that it says is designed to fix problems in today’s broken prescription drug system. The health plan is moving away from CVS Health’s Caremark as its sole pharmacy benefit manager to a model that brings together five companies “with like-minded philosophical and technology standards to build a new, innovative model following regulatory approval.”

The current pharmacy care system rewards some stakeholders for selling more drugs at higher costs, the nonprofit health plan said. Oakland-based Blue Shield is seeking to transform the system into a value-based model that provides members with the medications they need at a more affordable cost. Here are the five companies Blue Shield will work with going forward:

• Amazon Pharmacy will provide fast and free delivery of prescription medications, complete with status updates, as well as upfront pricing and 24/7 access to pharmacists.
• Mark Cuban Cost Plus Drug Company will establish a simple, transparent, and more affordable pricing model, reducing surprise drug costs at the pharmacy pick-up counter.
• Abarca will pay prescription drug claims quickly and accurately while continuing to evolve its technology platform, Darwin, to support new, simplified payment models.
• Prime Therapeutics will work with Blue Shield to negotiate savings with drug manufacturers to move toward a value-based model that aligns drug prices to patient efficacy and health outcomes.
• CVS Caremark will provide specialty pharmacy services for members with complex conditions, including education and high-touch patient support.

Once Blue Shield’s multi-year Pharmacy Care Reimagined initiative is fully implemented, the health plan expects to save up to $500 million in annual drug costs.

“The current pharmacy system is extremely expensive, enormously complex, completely opaque, and designed to maximize the profit of participants instead of the quality, convenience and cost-effectiveness for consumers,” said Paul Markovich, president and CEO of Blue Shield of California, in a statement. “That is why we are working with like-minded partners to create a completely new, more transparent system that gets the right drugs to the right people at the right time at a substantially lower cost."

“Amazon Pharmacy is thrilled to join Blue Shield of California in their effort to help members get the medications they need, when they need them, at a price they can afford,” said John Love, vice president of Amazon Pharmacy, in a statement. “With the help of Amazon’s upfront pricing, on-time delivery, and round-the-clock access to clinical care, we can provide a customer-centric pharmacy experience that supports better health outcomes.”