A year ago, Blue Shield of California announced that it would move on from a traditional pharmacy benefit management relationship with CVS' Caremark and instead adopt a new model that leans on multiple partners.
Now, the insurer is making one of its first major moves as part of the Pharmacy Care Reimagined model. Blue Shield is teaming up with drugmaker Fresenius Kabi and Evio Pharmacy Solutions to purchase a biosimilar for Humira at a transparent net price of $525 per monthly dose.
Humira, by comparison, has a market reported net price of $2,100, according to an announcement.
Through the program, most Blue Shield members will pay $0 out-of-pocket for Fresenius Kabi's adalimumab-aacf. Given the significant price cut, the insurer expects to improve medication adherence, drive down the overall cost of care and boost outcomes.
Matt Gibbs, vice president of pharmacy transformation at Blue Shield of California, told Fierce Healthcare that while the approach isn't necessarily unique to Humira, it "is the best selling drug of all time, so why not start there?"
"The ultimate goal is we want to get the actual price of a drug in front of a patient or member so they can actually make good, informed decisions about their options," he said. "We're not confined by kind of the legacy rules around pharmacy benefit management contracting that really make it difficult to do things like this."
While Blue Shield continues to have a relationship with Caremark for specialty pharmacy, it also brought in Amazon Pharmacy, Abarca, Mark Cuban Cost Plus Drug Company and Prime Therapeutics as partners in a modular approach.
Gibbs acknowledged that the insurer made headlines for taking such a first-of-its-kind step, but it also had to then prove that the model could actually work to address cost and improve transparency.
Other steps that Blue Shield has taken ahead of the full launch of Pharmacy Care Reimagined, he said, include working with Prime to carve out rebate aggregation from its relationship with Caremark.
He also touted the Synergie Medication Collective, a medication contracting organization that was co-founded by multiple Blue Cross Blue Shield plans, as key to the early days of the program ahead of its full launch Jan. 1.
"We've done things throughout this year that we could, while we're really focusing on the utility piece and the modular piece of it for January 1," Gibbs said.