A Q&A with Andy Chasin

Published November 20, 2023

The partnership between Civica and Blue Cross and Blue Shield companies is transforming drug affordability in the U.S. In this Q&A with Andy Chasin, vice president of federal policy & advocacy at Blue Shield of California, we delve into this visionary partnership, spearheaded by Chasin himself.

Andy, what first interested you in prescription drug costs?

I worked in the Senate on the Affordable Care Act. One of the first jobs I had was working on drug pricing. And at the time, I actually wrote the playbook for how to stop drug price negotiation. But over time, as I've seen the prices increase more and more for prescription drugs, I realized that was probably not the right decision for Americans or for our members. So I've spent a lot of time trying to think about how to lower prices for prescription drugs.

What was that ah-ha moment for you, when you realized prices were getting too high?

We were seeing things like Martin Shkreli, who was the famous “Pharma Bro” who got control of the price of a drug called Daraprim. It prevented a potentially fatal brain infection in infants. He said, “What's the value of that drug to a mother?” And the correct answer was infinite.

So he raised the price from $100 a bottle to $100,000 a bottle, and there was nothing we could do to stop that. I remember talking to a colleague and saying, “You know, what we need is a nonprofit drug company, somebody who could intervene when these things happen.”

And that’s where Civica comes in?

Exactly. So one day I saw an article announcing that hospitals were forming a nonprofit drug company. And when I saw that, I knew immediately, this is something that the Blues have to do. I literally took the article and I ran down to my CEO's office, Paul Markovich. I said, “We need to do this.”

He said, “Let’s give it a go. Do what you need to do.”

So I called Dan Liljenquist. I said, “Dan, I saw this. This is an amazing idea. We need to do this for Blue Cross and Blue Shield companies.”

And Dan said, “I've been waiting for this call.”

He knew that having the hospitals and the payers together really unlocked this potential to do great things, to help members with the cost of drugs.

Civica will launch insulin for no more than $30 per vial. How did the team land on insulin?

Going back to that first meeting with Dan and my CEO, Paul, we talked about the opportunity. And what Paul said was, “Start small, but think big.” And that's exactly what we did.

We started with drugs where we knew there was an opportunity to make a business case. Drugs like abiraterone [acetate], for prostate cancer. But in every single meeting that we had, the first question was, “What about insulin?” Insulin was always the goal.

The dream of Civica was to be able to bring nonprofit, low-cost insulin to our members. We just never thought it would happen this fast.

Given the nature of Civica, did you have a vision of the impact you wanted to have on people’s lives?

The whole point of Civica was to move the market to a better place. It was never to get Civica to manufacture every drug. It's to tell the market to price it fairly and we won't have a need to come in. But if you do something to keep these drugs out of the hands of Americans who need them, we now have an effective mechanism to do something about it.

The policy community has seen for too long that insulin—this essential, life-saving drug was just completely unaffordable. Americans today are having to cut their insulin dose in half, which isn't medically appropriate. They're having to borrow from friends, crowdsource these medications to make sure they have what they need to survive.

And people weren't doing anything about that. There was a lot of discussion, but what Civica did with the Blues, and other partners from nearly every corner of the diabetes ecosystem, was really get in and do something. We said, “We are going to make nonprofit insulin for $30 a vial.”

And what we saw, amazingly, was the market has already moved to provide insulin at $35 a vial for some patients.

Do you see this as a market disruption?

What I think is really unique about the partnership that we have with Civica is that we are making these drugs available for everybody in America. Whether or not you are a member of a Blue Cross Blue Shield company, whether or not you have insurance. And that is because we want to disrupt the system overall. We want to make these drugs affordable for everyone, not just our members. And that's a unique role that the Blues play in the American healthcare system. We're committed to the health of America, and that means looking beyond just the four walls of our companies to the system overall. How can we help everyone afford the medications and the care that they need? We want to see health care affordable for everyone, not just our members.

Speaking of that system-wide impact, tell us about your partnership with other Blue plans.

One of the things I loved about being able to build Civica with the other Blues was this amazing partnership that we had. We had a former McKinsey consultant from Highmark Blue Cross Blue Shield, the CFO from Blue Cross of Idaho, people who could prove that this business model worked. Without that participation from other Blues, there's no way we could have had the sophisticated analysis needed to show that this really was going to work.

Civica’s insulins now have a clear path toward FDA approval, and its manufacturing facility is nearing operational readiness. How does that make you feel?

I'm just proud of the work that we've been able to do with the Blue Cross Blue Shield Association and Civica to really make a difference for our members. I think it's why all of us want to work in healthcare. It's why we want to tackle these big challenges.

Next: BCBSA and Civica Partner to Revolutionize Drug Affordability

The Blue Cross and Blue Shield Association is an association of independently owned and operated Blue Cross and Blue Shield companies. Read more about how BCBS companies are promoting affordable health care