7 solutions for prescription drug costs
The U.S. spends more on prescription drugs per capita than any other country—outspending most of its peers by more than double, on average. These high and continually rising costs make life-saving medications unaffordable for millions of Americans. Nearly one in three adults report not taking their medicine as prescribed due to costs.
Among the highest-cost drugs on the market today are those that treat rare and complex diseases—particularly medical benefit drugs, or those that are injected or infused by a health care professional in a clinical setting. These treatments include multi-million-dollar gene therapies and chemotherapies.
To improve access to these critical drugs, a group of Blue Cross and Blue Shield (BCBS)-affiliated companies recently founded Synergie Medication Collective (Synergie). Synergie is a first-of-its-kind approach that prioritizes partnership and transparency to improve affordability, accelerate innovation and increase efficiency in managing the costs of medical benefit drugs. This new, independent organization will drive affordability by establishing a more efficient contracting model with pharmaceutical manufacturers and other industry stakeholders.
This is a new and vital way BCBS companies are driving transformation along the pharmacy value chain and advancing affordable, equitable care for Americans—but they have been leading work to address the high cost of drugs for decades.
1998: Prime Therapeutics forms
BCBS companies in Minnesota and Nebraska create Prime Therapeutics as a new pharmacy benefit manager in a market saturated by for-profit drug makers. Today, the company has grown into a leading total drug management enterprise across 23 BCBS companies.
2015: BCBSA makes specialty pharmacy solutions a national priority
Specialty pharmaceuticals are high-cost oral or injectable medications used to treat complex chronic conditions. As the market for these drugs began to take off, BCBSA’s National Group Purchasing Organization (GPO) committed to focusing on solutions to support all BCBS companies in making these drugs more accessible and affordable.
2019: Evio launches
Five BCBS companies—Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark Inc., and Independence Blue Cross—establish Evio: an independent company reimagining the pharmacy-patient experience and helping to ensure the right medications get to every patient, where, when and how they need it.
2020: BCBS companies co-found CivicaScript
CivicaScript was created in partnership with Civica and numerous Blue Cross Blue Shield organizations to bring affordable versions of common but high-priced medicines to market. Its mission is to manufacture and distribute quality generic medicines for a fraction of the price many consumers currently pay.
2022: BCBS companies pilot new payment model for cell and gene therapies
Unlike most high-cost chronic therapies, which are usually spaced out over time, cell and gene therapies are typically administered just once and can cost millions of dollars per dose. This makes paying for these treatments incredibly challenging. BCBS companies are piloting a new way to pay: an outcomes-based arrangement in which payers and manufacturers share financial risk, aligning payment to the success of the treatment.
2022: CivicaScript launches first drug and announces affordable insulin
CivicaScript now offers abiraterone acetate—a generic medication used to treat prostate cancer. The medicine is available to patients at a maximum retail price of $170—about $3,000 less than someone on Medicare Part D would pay for a comparable month’s supply. CivicaScript also announced plans to bring affordable insulin to market in 2024. CivicaScript also announced plans to bring more affordable insulin to market in 2024—costing patients no more than $30 per vile.
2023: Synergie Medication Collective launches
Synergie Medication Collective is a new medication contracting organization founded to serve both BCBS companies and independent health plans in improving affordability and access to costly medical benefit drugs.
The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield Companies.