{"id":119869,"date":"2023-06-20T22:40:40","date_gmt":"2023-06-21T02:40:40","guid":{"rendered":"https:\/\/www.thevalleyledger.com\/?p=119869"},"modified":"2023-06-20T22:40:40","modified_gmt":"2023-06-21T02:40:40","slug":"end-of-pandemic-could-mark-end-of-medicaid-coverage-for-some-2","status":"publish","type":"post","link":"https:\/\/www.thevalleyledger.com\/?p=119869","title":{"rendered":"Lowering Drug Prices through Innovation, Ideals, and Collaboration"},"content":{"rendered":"

By Capital Blue Cross \u2013 \u00a0THINK<\/a>\u00a0(Trusted Health Information, News, and Knowledge) is a community publication of Capital Blue Cross. Our mission is to provide education, resources, and news on the latest health and insurance issues.<\/em><\/b><\/p>\n

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When Capital Blue Cross announced in October 2022 that it had become the country\u2019s first health plan to collaborate with the start-up Mark Cuban Cost Plus Drugs, it set a precedent for the industry. It also opened a new door for Capital members to reap sizable savings on their medications.<\/p>\n

Capital remains the only health insurer in the nation collaborating with Cost Plus Drugs. That relationship recently brought Cost Plus Drugs founder and CEO Dr. Alex Oshmyansky to Pennsylvania to discuss drug access and affordability with members of the Lehigh Valley Business Coalition on Healthcare.<\/p>\n

\u201cFull credit to Capital,\u201d Oshmyansky said. \u201cA lot of organizations say, \u2018We believe in innovation. We want to be innovative.\u2019 But in my own experience relatively few actually are. Capital very much is.\u201d<\/p>\n

Conquering the Challenge<\/b><\/p>\n

The Cost Plus Drugs model is simple on the consumer side. Billionaire entrepreneur Mark Cuban set out to shake up the pharmaceutical industry with transparent pricing and minimal markups and fees. The online pharmacy charges consumers only 15% more than it pays to buy a drug from the manufacturer, along with a $3 per-prescription dispensing fee and $5 for shipping.<\/p>\n

Capital\u2019s challenge was replicating that simplicity on the health insurance side, according to Samir Mistry, Capital\u2019s vice president of pharmacy strategy and services.<\/p>\n

\u201cBecause (those within the healthcare industry) are used to complicated implementation, simplification actually makes it harder,\u201d Mistry said. \u201cSo that was the hard part, figuring out a way to operationalize and reflect Cost Plus Drugs\u2019 price on their website into our system so we can process claims.\u201d<\/p>\n

\u201cThe existing infrastructure is very complicated, so that\u2019s where you do actually have to create a fair amount of true innovation,\u201d Oshmyanksy said. \u201cHow do we reverse things from the convoluted system we have in the industry backward to simple commerce?\u201d<\/p>\n

Eventually, Capital and Cost Plus Drugs worked out the operational challenges, allowing Capital members to use their insurance coverage on the Cost Plus Drugs website \u2013 something no other insurer can do.<\/p>\n<\/div>\n

The Start of Serious Change<\/b><\/p>\n

Capital\u2019s collaboration with Cost Plus Drugs is doing precisely what both companies intended: saving members and employer groups money \u2013 in some cases, lots of it.<\/p>\n

\u201cAny member with prescription coverage that\u2019s a part of Capital Blue Cross or in our community, anyone who signs up and sees a savings opportunity, they\u2019re generally seeing discounts of 30% to 40% of the standard price,\u201d Mistry said. \u201cIn some cases, especially in our Medicare population \u2013 because it\u2019s available in Medicare Part D and commercial coverage for us at Capital \u2013 the highest I\u2019ve seen is a 98% savings.\u201d<\/p>\n

Mistry said the more dramatic savings, such as the 98% example he cited, surround generic oncology and specialty drugs, and can save employers or Medicare members hundreds or thousands a month.<\/p>\n

\u201cOne of our Medicare members is taking one of the (generic) oncology meds, and that\u2019s roughly $34 (as of June 7, 2023) on the Cost Plus website versus $712 (at CVS through GoodRx),\u201d he said. \u201cThis is a major savings for someone who\u2019s on a fixed income, living paycheck to paycheck.\u201d<\/p>\n

Capital\u2019s data has shown steadily increasing month-over-month member usage and savings through Cost Plus Drugs.<\/p>\n

Still, Mistry notes, there is room to improve.<\/p>\n

\u201cEvery drug is not available through Mark Cuban Cost Plus Drugs. That\u2019s OK,\u201d he said. \u201cIn innovation and disruption, it\u2019s not going to be perfect.\u201d<\/p>\n

Capital\u2019s next step is targeted outreach to members who might not yet be aware of potential savings through Cost Plus Drugs.<\/p>\n

\u201cWe\u2019re going to do focused initiatives towards them,\u201d Mistry said. \u201cIf they save money through the Mark Cuban program, then our employer groups, our plan sponsors, our company, everybody saves money. \u2026 So our focus point is always on the member.\u201d<\/p>\n

Oshmyansky credits Capital for having the vision to break new ground.<\/p>\n

\u201cI hope the relationship with Capital is a spark that ignites change throughout the industry,\u201d Oshmyansky said. \u201cI hope it brings attention to the fact that this is a real issue, that (high drug prices are) hurting real people, and hopefully helps bring positive change, not just to the Lehigh Valley and Central Pennsylvania, but to the country.\u201d<\/p>\n

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 <\/p>\n<\/div>\n

You can find more useful articles at https:\/\/thinkcapitalbluecross.com\/<\/a><\/strong><\/p>\n

Information provided to TVL by:
\nJERRY REIMENSCHNEIDER
\nSenior Public Relations Specialist | Brand & Market Strategy
\nhttps:\/\/www.capbluecross.com\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By Capital Blue Cross \u2013 \u00a0THINK\u00a0(Trusted Health Information, News, and Knowledge) is a community publication of Capital Blue Cross. Our mission is to provide education, resources, and news on the … Continue reading Lowering Drug Prices through Innovation, Ideals, and Collaboration<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":112634,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[69,482,5742],"tags":[],"class_list":["post-119869","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-in-the-valley","category-press-release-2","category-think"],"jetpack_publicize_connections":[],"acf":[],"jetpack_featured_media_url":"https:\/\/www.thevalleyledger.com\/wp-content\/uploads\/2022\/06\/capital-blue.jpg","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.thevalleyledger.com\/index.php?rest_route=\/wp\/v2\/posts\/119869"}],"collection":[{"href":"https:\/\/www.thevalleyledger.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.thevalleyledger.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.thevalleyledger.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.thevalleyledger.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=119869"}],"version-history":[{"count":0,"href":"https:\/\/www.thevalleyledger.com\/index.php?rest_route=\/wp\/v2\/posts\/119869\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.thevalleyledger.com\/index.php?rest_route=\/wp\/v2\/media\/112634"}],"wp:attachment":[{"href":"https:\/\/www.thevalleyledger.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=119869"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.thevalleyledger.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=119869"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.thevalleyledger.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=119869"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}