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Keeping high-cost drug therapies under control
Integrating prescription drugs and medical benefits can help contain rising costs.
Specialty pharmacy program
Specialty drugs have been the most significant contributor to increasing trends over the last five years. Our specialty drug management program provides convenient delivery options and support for members with complex conditions. Our program includes:
• Formularies designed to drive utilization to lower cost alternative medication where appropriate
• Utilization management developed to assure that only the right members get these expensive drugs at the right time and in the right quantities
• Industry-leading clinical support from specialty pharmacists and nurses
• Application of a total cost of care perspective across medical and
pharmacy benefits
Biosimilars can help reduce overall costs
Whenever new treatments for complex medical conditions come to the market, they are generally very expensive.
Biosimilars are less expensive, FDA-approved versions of commonly used high-cost biologic drugs. Independence continues to proactively monitor the drug pipeline and develop strategies for the best utilization and management of biosimilars.
Most Cost-Effective Setting program
Your employees want access to new and emerging treatments proven to be medically effective. We have taken great strides to incentivize savings by driving utilization of those services to the most cost-effective setting.
This program ensures that members with rare or complex conditions receive the appropriate medication in a safe and appropriate setting. Whether it’s their home, a provider’s office, or an infusion center, services in these settings could cost three to four times less than if received in a hospital. It’s just one more way your medical and pharmacy benefits work better together.
MEMBERS WITH COMPLEX CONDITIONS RECEIVE SUPPORT THROUGH SPECIALTY PHARMACY
• Cancer
• Hemophilia
• Hepatitis C
• Rheumatoid arthritis/ other inflammatory conditions
• Multiple sclerosis
12-15%
SOME BIOSIMILARS ARE PRICED 12 – 15% LOWER THAN THEIR RESPECTIVE BIOLOGIC.
2023 Large Group Plans | Independence Blue Cross 22
SAVINGS