IBX announces efforts to control drug costs
It’s a sign o’ the times, as I’ve said countless times in these pages. Payors are attempting to squeeze every last penny from between the links of the prescription-drug value chain. I single out the case of IBX (that’s Independence Blue Cross, the Philadelphia Region’s largest insurer with coverage of ~3.5 million lives) only because I’m a customer–hurray! The same thing is happening everywhere; there’s no place to hide. Recently, IBX announced two “cost-saving” initiatives that will limit consumer choice of new drugs (by limiting reimbursement and/or raising co-pays for innovative medicines) and hit innovator Pharma in the bottom line.
The first initiative is called FutureScript. It’s a PBM run by IBX (IBX is ending its relationship with Caremark for in-person Rx purchases; they will continue using Caremark for mail-in scripts) that will initially manage IBX’s commercial Rx drug program and soon thereafter its Medicare program as well. Basically, IBX argues that having its own PBM allows it to better control costs. What that means for consumers, however, is that owning its own PBM allows IBX to offer less choices at higher co-pays for its customers compared with Caremark, which faces the pressure from a larger, less-captive customer base.
The second initiative is the Select Drug Program formulary. This is an aggressive formulary management program that automatically excludes all new branded drugs from from Tier 1 and 2 co-pays (IBX uses a three-tier co-pay structure) and subjects new drugs to pre-authorization (case-by-case; nothing new there). Generics are automatically added to the formulary at the first tier (i.e. lowest co-pay) and the innovators they replace are automatically consigned to the third tier (i.e. highest co-pay). Again, that’s not new.
What is new is a practice that IBX describes as a convenience to some consumers: shifting some self-injected meds from medical benefits to drug benefits (and from doctor’s offices and hospitals to retail drug-store shelves). These drugs can now be conveniently picked up at the pharmacy, where they might or might not be covered with a Tier 3 co-pay. How convenient (use Dana Carvey’s Church Lady voice for maximal impact when reading the foregoing).
In addition, IBX is clamping down on the practices of docs who routinely inject meds in their offices by hooking up with vendors who will monitor the use and cost of such injections to provide IBX with the most “cost-effective” purchases. If you’re a doc in the Philly area, you may read this as further invasion of your practice for the sake of saving insurers money. But don’t bother complaining, lest you risk insurers exhorting you to climb down from your big blue cross.
