Pharmacy integration

[SCREEN TEXT] Adverse Reactions: Managing Pharmacy Trends & Cost Drivers

Webcast for HR professionals, June 21, 2022

[Julie] All right. Welcome and good morning, everyone. My name is Julie Knaack, and for those of you that don't know me, I manage our team of healthcare consultants here at Blue Cross North Carolina.

[SCREEN TEXT] Today's Host: Julie Knaack, Manager, Healthcare Consulting, Blue Cross NC

I am delighted to be your host today for today's webinar, Adverse Reactions: Managing pharmacy trends and cost drivers, and I am going to do my best to make sure that this is both rewarding and enjoyable for the next hour.

So this is actually the second of a series of webcasts that we're delivering this year to share the latest trends that we face in health care and the innovations to deliver better quality, affordability and an exceptional experience. And today, we hope to bring you a very interactive webcast where you will gain an understanding of the key trends in the pharmaceutical industry, how these trends are contributing to higher prescription costs and treatments, and what considerations you may have that impact your company's total cost of care while designing a health plan that's distinct in improving patient health outcomes, experience and affordability.

We have two great speakers that I will be introducing shortly, but first I want to just walk us through a few housekeeping items.

[SCREEN TEXT] Housekeeping

Your participation matters

Submit questions via Q&A box

Eligible for SHRM PDC & NCDOI CE credits

Take our Survey!

So, first of all, you heard me say before this is an interactive webinar, so we hope that you will be attentive to some of the poll questions and other questions posed by the speakers that you'll have a chance to respond to in both the chat and the Q and A. But this also means that we want you to try to minimize as many distractions as possible. So if you can put your cell phone to the side, make sure your your dog is not going to bark at the Amazon delivery man, etc., that would be great.

Second, when you do want to submit a question, we ask that you use the Q and A feature. This is at the lower part of your screen. We will be answering those as much as we can along the way, but also have some time at the end to address those questions.

Thirdly, this webinar is accredited by SHRM and is eligible for professional development credits through also the continuing, um, through NC State's insurance certification program. So if you are in need of those professional ed credits, make sure that you submit for this one, our one-hour webinar.

And then also at the end of today's webinar, we'd love for you to take our attendee opinion survey, as your feedback on today's session is really valuable to us. And in doing so, you would be entered into a drawing for one of four $25 Amazon gift cards. So thank you in advance for your opinions in helping us deliver some excellent webinars that are helpful to you.

So before we get to the intro of our speakers, I want to uh see if we can get our interactive skills going here. And with the slide advancing next, this is an example of one of the poll questions that we have for you today.

[SCREEN TEXT] According to the National Business Group on Health Survey, what % of spending does Pharmacy represent in total cost of health care?

A. ~10%

B. ~20%

C. ~40%

And the question is, "What percent of spending does pharmacy represent in total cost of of health care?"

This question actually comes from a survey that was delivered by the national business group on health which, for those of you who may not be familiar with them, is a very active non-profit that uh represents the um perspectives of large employer groups on topics related to health policy and other workforce strategies, particularly related to health and well-being.

So seeing the answers come in and, uh, spoiler alert, I'm about to reveal the answer is actually B. 20 percent of spending is related to pharmacy, and you'll be surprised to know that over half of that amount is actually dedicated solely to specialty drugs. So that's a big part of our conversation today, and I think, um, understandably is an area that we're doing as much as we can to help control costs.

[SCREEN TEXT] LEARNING OBJECTIVES: 

1. Rx drivers of health care spending
2. Growing importance of Specialty Rx
3. What's on the horizon for Rx
4. What can be done to address trends

So the learning objectives for our webinar today are listed there in front of you. We are hoping to help you build an understanding of what's driving the escalating cost of pharmacy and how that's impacting your health care dollar, how specialty drugs are playing a major role in all of that, and then what we as employers, employees, as health plans, can do to address the rising pharmacy cost both today and in the future.

[SCREEN TEXT] Adverse Reactions: Managing Pharmacy Trends & Cost Drivers

Today's Presenters: Arif Khan, VP of Pharmacy Services, Blue Cross NC

Joseph Albright, Director of Pharmacy, Blue Cross NC

So without further ado, I want to take a minute to introduce our speakers today. We have two expert presenters to take us through this topic, and I want to tell you a little bit about each of them before I disguise a "hello" as a sound check to make sure that their speakers are working.

Arif Khan is our VP of pharmacy services and just celebrated his one-year anniversary here at Blue. In his role, he oversees all aspects of corporate pharmacy, including formulary, networks, operations, specialty management and pharmacy strategy and innovations. Prior to joining Blue, Arif spent his time in management and strategy consulting, first launching a firm in Washington DC, followed by eight years at Care First Blue Cross Blue Shield in a couple of VP roles. He was vice president of pharmacy management and then later vice president of clinical programs and evaluation. But we all know that the real reason that Arif was hired is he graduated from the University of North Carolina Chapel Hill and also is a little bit of a mover and a shaker. He's been recognized recently by several organizations, including the Maryland Chamber of Commerce, The Daily Record Successful by 40, and was named to the Baltimore Business Journal's 40 Under 40 Award. So definitely got some good stuff coming at you from Arif this morning.

And then, also in the league of impressive young professionals, we have Joey Albright. And Joey is a pharmacist here at Blue who directs our commercial pharmacy programs as a director and serves over, in that role, serving over one million members. So Joey oversees a lot of our traditional programs, such as network formulary and utilization management, but also has been uh pivotal in advancing our partnerships with ACOs and self-funded employer groups. Joey has been at Blue for six years and really, um, I've done a lot of work with Joey, has built a pretty solid reputation for success in modernizing a lot of our clinical policies, particularly around opioid use, and is incredibly knowledgeable on topics such as diabetes management.

So I want to welcome both of you and thank you for joining us on this topic today. And to get us started, turn it over to you, Arif.

[Arif] Excellent. Thank you so much, Julie. I am uh excited to be here and to uh go through what should be, hopefully, an engaging and fun presentation with uh all of you.

I'm glad to see uh that first poll question, looks like quite a few of you chimed in in the chat, which is great, because I am going to do my best to make this a uh an engaging conversation and I'm going to ask you guys a bunch of questions that I want you to respond to in the chat as well.

[SCREEN TEXT] Prime Therapeutics

Pharmacy Benefit

Manager (PBM)

Partnership

North Carolina's largest insurer, providing coverage to more than 4.25M members across all 100 NC counties

So, with that said, um I wanted to start off just with a quick introduction uh at a high level to talk about um sort of how we're structured and the operation at scale. And then I'm gonna get into a little bit about um you know, sort of the who's who and what causes drug pricing to be high and things like that.

So, at the forefront, uh you all know that Blue Cross North Carolina has a owner investment partnership with Prime Therapeutics to serve as our pharmacy benefit manager or PBM. You'll hear a lot of acronyms and so I'll try my best to define those as we go. That's been a long-standing partnership. Together, Blue Cross has about, north of 4 million lives for medical, about a third of that has our pharmacy coverage, um and so that's an important number to remember.

[SCREEN TEXT] 1.3M Rx members served

There are some questions earlier on about um you know how much do we spend. You know the numbers that were shared earlier, I think, were sort of a national number. When you think about Blue Cross specifically, uh let's see if we can get in the chat, people asked about drug spend, so I'm saying drug spend irrespective of benefit. Love to see how much you guys think we spend on drug in any given year, um total. So if you guys will go ahead and put it into the chat, I'll give you guys a second and then I will uh reveal the numbers.

All right. Billions, that's that's good. Hopefully that's not a reference to the Showtime show, but 50 million. Okay, good. All right, 100 million. Okay, I'm seeing numbers all over the place. Here's the big reveal. I wish I had a drum roll, but I don't.

[SCREEN Text] $2.5B in Annual Rx Spend

Two billion is pretty close. It's two and a half billion dollars in annual drug spent. Just a little bit of context to that number, um and important for you all to know based on where you sit in your respective organizations, uh that number is almost a third of our spend at Blue Cross North Carolina. We um as we think about it, unfortunately, that number continues to grow and it's growing at a rate faster than a lot of other areas in health care. And so that's why it's an even more important area to manage.

And for us, we're really keen on thinking about, not what i call insurance "guppy goop," right? Whether it goes on the pharmacy benefit or the medical benefit, but thinking about drugs spent holistically, right? And one of the reasons that's most important, you heard Julie reference specialty, specialty drugs make up about 40 to 50 percent of this overall spend, right? And you think about it, specialty utilization is actually very low. There's only one to two percent of a population in any given payer or in any of your organizations that makes up that specialty spend. But it's almost split half and half across the medical pharmacy benefit, so again, uh brings up the the importance of making sure you're managing this holistically.

And then if you think about, from an operational perspective, what that means, we process about 14 million claims a day.

[SCREEN TEXT] 14M Rx Claims annually

And that's important to know because, um you know this is a huge operation, and while we're not gonna spend a lot of time today talking about the operational components, uh i do wanna call this out because you'll hear a tagline from us at Blue Cross about uh being brilliant at the basics. And so um if any of you have your calculators out, I'll give you a chance. Anybody know how many claims that is that we process every single day?

If you divide 14 million by 365, I think it comes out to about 38,000 claims or something like that. Good. Somebody beat me to the calculator. And so, if you think about it, and you all should hold us accountable, this is your job and we owe that to you to be perfect or as perfect as close to perfect as we can. But, um, generally speaking, 38,000 claims every single day, majority of them are working exactly the way they should be. And sure, there's always a handful of issues that pop up, as is par for the course in the business, but our job is to be flawless and you should hold us accountable. But, I'm still waiting for the one day I get a phone call where somebody says thank you for all the, I don't know, 37,900 claims that processed correctly uh over the course of the day.

So with that little bit of context, what I wanted to do is zoom out before we zoom in. And what I mean by that is, um, I’ve spent a lot of time in my career kind of teaching pharmacy, right? Because it is a complex area, it's got a lot of hands in the pot, there's a lot of lack of transparency. And all those things are true. And one thing I realized was when I was um uh at Care First, I had a, you know, a similar role overseeing pharmacy and was talking to brokers and consultants and HR folks and um would do some teaching of the sales team, right? Because they needed to hear this stuff so they could come talk to you all. And then I had a six-month stint where I oversaw the care management team. So they were in the healthcare division, a peer of mine, and I realized when I started talking to them, assuming they knew how pharmacy works, none of them even knew. And so I realized, "Oh, we really got to help people understand how this entire operation uh works."

So, what we're going to do is just talk a little bit about product and service flow across uh across pharmacy, and we'll have some fun with it. So hopefully you guys are ready in the chat. Thank you guys for engaging there. This is great.

And the first question is, "Where do drugs come from?" And if somebody says "cartel," it's the wrong answer. All right, there we go: "pharmaceutical manufacturers." Perfect. "A lab," "labs." Yup, okay.

"Pharmacy," "pharmaceutical manufacturers" is the one that I was looking for. So that is kind of the first step in the process, right?

[SCREEN TEXT] Pharma Manufacturer

You have pharma manufacturers who are the ones who actually, um, are the ones producing medication. We'll talk about R and D in a couple slides in a minute here because that's part of what they do. But there is a little bit of, uh, uncovering I want to do there. And most importantly, they commercialize the product and they set what is called "list price," right? The price that a drug is actually priced at, and we'll talk a lot about that, too, because it's an important topic.

Can anybody tell me who pharma manufacturers then sell the product to? "Wholesaler," good. "Distributors," yep that's right. "Wholesalers and distributors," that's exactly right. So, great I normally have to give a hint about Costco and then people get it but you guys are smarter than I thought.

[SCREEN TEXT] Pharma Manufacturer 

Wholesaler/Distributor

Wholesaler purchases drugs from manufacturer

So, here we go. Um they sell them to wholesalers or distributors. There's actually three major wholesaler distributors that make up about 90 percent of the market. Uh those three are, if anybody knows them, you can throw them in the chat. But Ill spill it out. Uh it's AmerisourceBergen, Cardinal and McKesson. Yep, perfect. Wow, you guys are you guys are really good at this stuff. Um so they make up, again, about 90 percent of the total market here. Their revenues in a given year are about 450 to 500 billion dollars, right? So these are massive, massive institutions that are doing a lot of the purchasing of medication.

And then, next question here is, "Where do they actually then distribute that medication to?"

"Pharmacies," yes. Perfect.

[SCREEN TEXT] Pharma Manufacturer 

Wholesaler/Distributor

Pharmacy

Wholesaler purchases drugs from manufacturer

Pharmacy purchases drugs from wholesaler and takes a dispensing fee from PBM

All right, that is generally the flow. Of course there's other uh players in this in this model, right? Some of the sales happen to hospitals and to other, you know, providers, etc. But generally speaking, as we're thinking especially over retail side, uh they end up in the pharmacy's hand here, right? And so think of your Walgreens, CVS, uh Giant, Harris Teeter, uh your independent pharmacies, right, whoever they might be uh where the product is actually flowing. And then as you know, that product will make its way into a member's hand from there.

And the next question is, "Who is reimbursing the pharmacies for that service?"

Good. "PBMs," "payers." That's right.

[SCREEN TEXT] Pharma Manufacturer 

Wholesaler/Distributor

Pharmacy

Pharmacy Benefit Manager

Wholesaler purchases drugs from manufacturer

Pharmacy purchases drugs from wholesaler and takes a dispensing fee from PBM

PBM reimburses pharmacy for cost of drugs dispensed, and charges Payor more to create margin

So that next intermediary, there is a PBM. It is the PBM who is in fact reimbursing that pharmacy, and I see "insurance companies help PBMs." Yup.

And so that kind of leads me to the last uh kind of player in this in this who's who, which is, "who is it that, in fact, the PBM is reimbursing on behalf of?"

[SCREEN TEXT] Pharma Manufacturer 

Wholesaler/Distributor

Pharmacy

Pharmacy Benefit Manager

Patient

Wholesaler purchases drugs from manufacturer

Pharmacy purchases drugs from wholesaler and takes a dispensing fee from PBM

PBM reimburss pharmacy for cost of drugs dispensed, and charges Payor more to create margin

Payor pays PBM on behalf of the patient for adjudicating claim, managing benefit, and contracting pharmacy network

Right, and that is the insurer. And so that gives you a quick review of how this, kind of, the stakeholders pull together here in this space. There's a couple things I want to talk about before we move off this slide. The first is, um as you can see, that little dollar sign that's bouncing from, you know, circle to circle, circle to circle, um, that concept is true, right? This idea that there are, uh, that, um, that terrible "m" word that you hear all the time, right? There's a lot of middle men that play in this space, and they often times add to the cost of medication, right? Because, ultimately, what I want to get to is having this conversation about "What is it that cause causes drug pricing to be high?"

And so, yes, there are middlemen right? And you could argue that any one of these bubbles is a middleman. And, yes, they all do take margin, right? So wholesalers do and pharmacies do and PBMs do and even insurance companies and payers do, right? And certainly pharma manufacturers do as well, um, but there's a couple things I want to call out. I have a, I have a strong belief that just about everybody on this page has been a culprit of the "So what?" right? Like, what is it that causes drug pricing to be high?

I think everybody here has been part of that problem, right? Everybody here has added to the cost of drug at some point in time in the process over many years that has caused drug pricing to go up. But, there's two things: One is, I actually will pause it to you and we'll talk about the next few slides, why I believe pharma manufacturers are the the ones who have contributed that to that the most, and, actually I think are the ones who go probably the most unscathed because there's a lot of finger pointing like this that happens and a lot of times we get lost in, uh, some of the optics and and not the reality of where some of this stuff is happening.

The second thing I want to call out to your attention is while I do believe payors have a hand in this, I take pride in the fact that I work at Blue Cross North Carolina, which is a not-for-profit entity, right? And so we take that very seriously. Our job is not to, um, squeeze profit out of these processes and try to pad our bottom line. Uh you know, on a $10 billion-revenue company, that Blue Cross North Carolina is, you know we're making less than a percent oftentimes in many years, uh, quote unquote in profit, right? And so the idea for us is not to squeeze margin out of this or make a lot of profit. And sure, there are areas where that happens. Any business has to find a way to keep itself afloat, but ultimately that's all coming to our bottom line. And, again, it's a fraction of a percent or a percent or two that happens, not the profit margins you see in a lot of these other places, which are oftentimes in double digits.

The other thing I'll talk about, I mentioned this earlier, was list price. And it's really really important to understand, uh, I think when pharma sets list price, it goes, it's completely unregulated, right, which is a very interesting topic. The fact that they come out with a drug and say, "Let's set the price at a hundred thousand dollars," when maybe that drug could have been ten thousand dollars, right? So you've already created a ninety thousand dollar spread there. If you think about the wholesale, the pharmacy, the PBM or even the payer, like each of those entities might add three percent, five percent, seven percent, whatever that number is, that they're taking as their margin. But none of that's going to compare to that original $90,000 spread that was created at the outset.

So really important topic to keep in mind, uh, and something I'll talk a little bit more about uh in a few slides because um obviously one of the questions you hear a lot about is uh is R and D, which we'll uh dig into.

[SCREEN TEXT] HEALTH PLAN VS PBM

So, one thing I want to just cover real quick before we jump into the fun part is you know there's a lot of conversation about um, "Well, great. Let's just get rid of PBMs," for example. And while I think that's a cute thing to say, I think it's actually a lot harder to do, and I'll I'll explain why. If i was to poll all of you, I did this when we had our health care symposium with a bunch of employers, if I was to poll you and say "How many of you want to, uh, like get rid of Blue Cross North Carolina and do all the things that we do yourself?" how many people would raise their hand? And when i did this with about 150 people, one person raised their hand and I think they were joking.

So the reality is, uh, claims processing, managing a network, maintaining eligibility, enrollment, etc., those are very difficult tasks, right? And so the idea that you can just sort of poof that entire operation and take it in-house or do it somewhere else, it's actually not that simple, right? Like even when we think about the PBM contracting with the network of pharmacies, there's 70,000 pharmacies across the country, right, that they're networking for us. They're negotiating rebates and and uh discounts with pharma manufacturers. They're helping with clinical protocol and policies, right? P and T committees are working together, right?

So there's a lot of work that happens, so it's not as easy to think that like, "Yeah, let's just get rid of them." Are they part of the problem at times? Sure, they can be, uh, but our job and our partnership with Prime is to make sure we're squeezing that process to ultimately drive down costs and increase uh affordability and access for for all of you and your your employees.

[SCREEN TEXT] HOW MUCH DOES BIG PHARMA SPEND ON: SALES & MARKETING VS. RESEARCH AND DEVELOPMENT

Johnson & Johnson: $17.5 sales and marketing, $8.2 research and development

Novartis: $17.5 sales and marketing, $8.2 research and development

Pfizer: $11.4 sales and marketing, $6.6 research and development

GSK: $9.9 sales and marketing, $5.3 research and development

MERCK: $9.5 sales and marketing, $7.5 research and development

SANOFI: $9.1 sales and marketing, $6.3 research and development

Roche: $9 sales and marketing, $9.3 research and development

AstraZeneca: $7.3 sales and marketing, $4.3 research and development

Lilly: $5.7 sales and marketing, $5.5 research and development

Abbvie: $4.3 sales and marketing, $2.9 research and development

IN US BILLION, FOR 2013

So, um, I wanted to spend a little bit of time to uh to talk about, as my slide progresses here, uh, one of the big things you hear, right, which is when you hear pharma say, "Well, look, we're not just setting this price high for no reason. It's actually because we have um a bunch of R and D costs and it takes us a lot of money to put in uh to bring these life-saving medications to you, and so we're just trying to kind of, you know, break even, make a little bit of money." Um and this was a very interesting visual from Dadaviz, and interestingly the person who put it together, it was a long time ago, and now when I try to find them on the internet, I can't find them, so who knows if somebody got to them.

Uh, but they put together this uh fascinating visual which takes a look at a bunch of household names and large manufacturers that you know, right? Johnson and Johnson, Pfizer, GSK, et cetera. And it took a look at how much they spent on sales and marketing uh versus R and D and as you can tell from the bubbles, a lot more money spent on sales and marketing than it is on uh R and D. So, important to keep that concept uh in mind as well.

Uh the other thing I want to ask folks is, and let's see you all kind of get engaged in the chat on this one, "Who is it that actually funds a lot of R and D in this country?"

"Pharma companies and VCs," "US government," "taxes," "government," yep, yep. "Federal government." That's right. So, uh another common misnomer for folks that they don't recognize is usually a lot of the R and D that goes into commercializing product actually starts with uh government institutions like the NIH, for example. Universities. Uh there are philanthropic and institutions out there that are trying to uh start some of this work as well. Uh and so it's actually, and and you know it's June now, we're coming off April, hopefully you guys all filed your taxes on time or requested a request an extension, but uh you know raise your hand if you're one of the people that funds the government.

Rght. It's all of us. So it's in fact all of us that are the ones that are um funding a lot of this R and D that actually happens, right? So it's important to keep that concept in mind as well. You know what's fascinating is I looked as I was doing some research for this presentation, um there was a study done, and this was 2017, so a few years ago, uh that took a look at two big players, right, Pfizer and J and J, and said, "How much of the early discovery, like early development work and discovery, was conducted in-house for the products that they made that year?"

So for Pfizer 10 of their 44 products, meaning only 23 percent, were were made off of R and D and early early discovery work that they did in-house. For J and J, it's even worse. Two out of 18. So only 11 percent of their products that came to market that year were sourced originally by research that they had done themselves in-house, right? So again, this idea that pharma oftentimes comes in after the research and development has gotten to a later stage and shows promise to be commercialized, that's when pharma and VC somebody mentioned will come in and actually try to commercialize that product. So important to keep that concept in mind.

Another thing, you know as we talk about R and D, uh you know how many of you watch the Super Bowl, right? We're June now, February, sports are coming to a close and now it's just baseball season, so you're a baseball fan lucky for you. Uh I miss basketball and football, um and you know if you watch the Super Bowl, you all know the commercials are probably sometimes more fun than the game. And I if I asked you to raise your hand if you saw a drug commercial during the Super Bowl, I bet you just about every one of you would raise your hand, right? And we know that those commercials, 30 seconds to a minute is north of $5 million, I think is the going rate right now, and you know that probably just about every year we see a commercial from a drug company or multiple drug companies during the Super Bowl.

So it's pretty fascinating. There's some research done by Public Citizen, and you can Google this to find the references, and it talked a lot about um some research that was taking a look at two drugs that came to market. I'll talk about Jublia. This is about 2014, I believe, It came to market. They aired a Super Bowl commercial in 2015 for it, I think. It came to market late in 2014. Um and this drug is used for toenail fungus, in case anybody's wondering. Um and it was fascinating because they said, "Look, this is a new product coming to market. It's naturally going to have an increase in utilization." So they uh, based on their study this is, sorry this was the University of Pittsburgh, they said uh the utilization on that drug would be about 40 percent increase um if if all things stayed equal. They ran a Super Bowl commercial in that February. Any guesses as to what the utilization actually ended up taking up uh after the Super Bowl commercial?

"60 percent." Good guess. "70," "50." It's like Price Is Right. You have to come in as close as you can without going over. "75." "65." "75." "60." Yeah, so it's about 91 percent, right? So more than double the expected utilization because of that Super Bowl commercial. So this idea that direct-to-consumer advertising works is absolutely true uh and an important topic, as well, to keep in mind.

A couple other things I want to call out. So there's a Health Affairs blog post that talked about this as well. In 2015, they looked at the top 15 drug companies making the top 20 drugs globally, okay. And it looked at how much the US pays in prices for drugs, um, and what it found was that the US pays, on average, 2.4 times more than the other five advanced nations that were in that study, which were Canada, UK, Denmark, Ireland. There may be one other that I’m forgetting. Um and so it's amazing, right? In 2015 for those top 15 drugs, Americans paid about $197 billion dollars, or $116 billion more than the citizens of those other countries, right? So we're going to talk a little bit more about that in a couple slides, but important concepts to keep in mind.

Let me move forward and I'll give you a couple more stats as we go.

[SCREEN TEXT] Daraprim: $13.50 to $750 per pill

So who remembers this guy? Anybody remember his name? Throw his name in the chat if you do. "Pharma bro." That's right. "Martin Shkreli," "pharma bro," "public enemy number one" would also be the correct answer. Uh that's right, so you all remember. Um as a funny side note, I was presenting this to Appalachian State class a couple couple months ago because the professor asked me to talk about this stuff, and I I popped this guy on the screen and silence. And I just thought maybe the class was like, you know, not engaged, not enjoying the presentation, uh and I was like, "Come on, guys. This was just a few years ago." One kid raises a hand. He's like, "I was five when this happened, so i don't remember this." I was like okay, that's that's a fair point. Um so I’m glad you all remember him. Um so you all remember this guy. A couple years ago. He is currently in jail and, for unrelated reasons, but a couple years ago he became public enemy number one because he decided to, or his company decided to, buy the manufacturer that was making this drug, Daraprim, he used to be selling for $13.50 a pill and overnight he increased the price to $750 bucks, which I think is a 5,000 percent increase in price overnight, right? Uh and again, back to that point I made earlier about the lack of regulation in pricing and list price, this is a perfect example. And if you remember, he ended up having to come to Congress to testify on the Hill. He got called out in just about every news publication and article. He was on the nightly news, there was bills being drafted, and you know, uh politics aside, because I don't really care what anybody's politics are, left, right, citizens, Democrats, Republicans, like it doesn't matter, everybody agreed that this was egregious behavior, a problem and should not happen, right?

So it's pretty rare that you get everybody from every side and every walk of life saying, "Yeah, this is a problem. We have to fix it." And the fascinating thing is after all of that hoopla, let me ask you all, "How much do you think Daraprim costs today?"

You throw in the chat. Yeah, the same. Sheila, you got it first, I think. 750 bucks. So uh just imagine after all of that, nothing actually ended up changing. Um the other thing to point to the fact that politics are aside, right, like I think at this time President Obama was in office, um so like, you know, that was quote unquote his issue, so if you're if you're on the left and a Democrat, like great, nothing happened. President Trump then ran on the idea that he was going to kind of influence the space and get rebates to go away and change the industry. That one fell flat. President Biden ran on the same thing now, not much has changed, right? So, again, it doesn't matter if you're left or right, but this is an issue that that affects all of us but doesn't seem to be getting better.

[SCREEN TEXT] BIG PH(A)RMA

One of the reasons for that is, in fact, the title of the slide. Anybody know why I have that "a" in parentheses? Any guesses? I'll give you guys a hint. "Advertising," no. Uh the lobbying group that represents pharma is actually "Phrama," so um so they are a big reason why uh, in fact, a lot of a lot of this stuff doesn't change. Um, it was fascinating, again, when I was looking at some of this stuff, um and this is old statistics, right, this was from like the late '90s, early 2000s. It talked about how the drug industry hired 625 different lobbyists that year, or more than one lobbyist for every member of congress at the time. And the total amount they spent was about $262 million dollars in lobbying in the '99-2000 election, right? So this is 20-years-old data. Imagine, fast forward what that looks like in today's numbers.

So, let me give you guys a couple of, a fun game that I call "Pharma Math." So uh if you were at your local, pick your store, grocery store or whatever it might be, and you needed to get a little bit of ibuprofen, 30 tablets, generic, right? Not Advil, but ibuprofen. How much would that cost? Throw your guesses in the chat.

"$7.50. "$6," "$6." "$6 25." I should probably caveat that I put this together probably, I don't know two or three years ago. "$1.50." So maybe inflation has hit. I know we're all feeling it. But at that time, uh it would have cost about $1.99. All right, uh, let me ask you all, uh rough night out had a lot to eat, not feeling comfortable, need a bit of Pepcid AC. We've all been there. Um, how much would some Pepcid AC cost at your local grocery?

[SCREEN TEXT] Ibuprofen: $1.99 + Pepcid AC: $15.99

All right, 15.99 is the answer. All of you were pretty close. There is a product, uh, that pharma has made. It's called Duexis.

[SCREEN TEXT] Ibuprofen: $1.99 + Pepcid AC: $15.99 = $3,160.25

It is actually the combination of these two products together and, um, oh I spoiled it because I probably clicked. I was gonna ask you all to guess how much uh two dollars plus sixteen dollars equals in pharma math. Uh the answer is unfortunately not eighteen. It is, in fact, three thousand one hundred and sixty dollars. So that is uh the unfortunate reality of what we have to live with when it comes to uh pharma math.

A couple other topics that I'll touch on real quick and then I want to make sure I wrap up to leave time uh for Joey and um the rest of the team to chime in here. So I just wanted to call out, uh, as we think about this uh concept of uh of how much we pay for drugs in this country, right, uh an example I oftentimes use is uh, you all remember because in your roles uh this was a huge huge issue back in like the 2000, I don't know, 13, 14, 15, whatever it was, when the hep c products came out, you know these blockbuster drugs, which are amazing, right? Curative treatments for hep c. That wasn't the case before, um but they came out at a sticker price of ninety thousand dollars for a three-month supply of the medication, right? Gilead was one of the main producers at the time, manufacturers at the time, the first to market. Um let me ask you all, you can throw in the chat, I'll go ahead and just for the sake of time, keep it moving, like any any guesses as to how much Gilead sold that, so exact same manufacturer sold that exact same product for in Egypt, right? Not a knockoff. Not a, not a a generic version of it. Not some other manufacturer, right? Same exact one.

A thousand bucks, right. so a 90 x multiple on what we pay here versus there. And look, I believe, again, whatever your your perspective might be on this, I believe that it's okay for the US to pay more as as compared to maybe a developing nation, for example, um because you have to adjust for cost of living, that kind of stuff. The issue I have, though, is that these pharmacy manufacturers are, in fact, mostly all international companies and um I found some great research that talked a lot about, it's in a Health Affairs blog post as well, that talked about how much the international price is as compared to the US price for major products across most of these manufacturers. And the average is that the international community pays about 41 percent the price that the US pays, but here's the kicker: the revenue, right, the revenue that these pharma manufacturers make from the US premium alone as a percent of their global R and D budget, meaning how much they spent globally on R and D versus how much money they made just from US sales, is actually about 163 percent. So what that means in like layman's terms is they make up their entire R and D budget just from US sales alone. And don't forget they're selling all across the entire world. So they are, in fact, making massive massive profit margins uh that in fact uh are padding their numbers and making it um what I believe is contributing to this price issue.

[SCREEN TEXT] VALEANT

FEB. 1, 2008: $13.24/Share

AUG. 5, 2015: $252.62/Share

So, with that said uh let me close with this. Um you all have a homework. Uh I'd ask you all who has a Netflix account, and if you don't, I’m sure you share somebody's password somewhere. You all should watch this documentary. It's called "Dirty Money." Uh episode 3 is about pharma. So if all the things I’m saying sound a little bit far-fetched and that doesn't make sense or that couldn't be true, here's a real-life example with some investigative journalism that will show you uh how this stuff plays out. So I'd encourage all of you tonight to watch this when you get some time, kids go to bed or sit with them and watch it too.

[SCREEN TEXT] WHAT CAN WE DO?

Balancing clinical efficiency, drug cost and providing the necessary care coordination to members

Um so, what does that mean? What can we do? Um I’m gonna actually pass it off to Joey because he's gonna walk us through this. Just a quick couple of highlights: One, got to get better at managing cost, and that means pressuring in the right ways, whether that's at federal regulation or pegging our price to international ways, like all that kind of stuff is important for us to think about. Two, as a payer, our job is to think about cost and always at, without without compromising clinical quality, but those things in combination because you can't look at one or just the other. And then thinking about all the tools that we have and innovative partnerships that we can formulate that are going to help bring these things down. So, with that said, I will pass it back to Julie and Joey, Julie and Joey, to walk us through what Blue Cross is doing in particular.

[Julie] That is great. Thank you, Arif. That was really helpful and very informative and interactive. You definitely delivered on that. It was uh interesting and fun to see the the different responses coming through the chat for sure.

So, yeah, I do want to transition us to a conversation about what we can do and really leverage the expertise of Joey Albright to um kind of walk us through some of those things and um, you know, one of the the areas that uh, you know, I introduced Joey on was that, Joey, you have a lot of experience with uh innovative relationships and bringing new solutions to Blue.

[SCREEN TEXT] INNOVATIVE PARTNERSHIPS

EQRx, Audaire & Hemophilia Network

And um a couple of them that have landed this year, and you know we're looking to bring on in the next few months, are listed on this slide. Um and, you know, when I was looking through this presentation, I couldn't help but just think about hemophilia for a little while because this is definitely a condition that pops up periodically when my team is doing utilization reviews with groups and is always one that, you know, gives a group pause knowing that this is going to be a cost driver uh for for several years, but also just feeling like there's not a lot that they can do about it. So I'd love to just hear a little bit more about um what we're doing in that space as well as uh anything innovative that we're doing related to specialty drugs.

[Joey] Yeah. Yeah, sure. Actually, I’m gonna start on the EQRx side, but the the hemophilia comment is a good one since we have some good progress there. Um we're gonna go right back to actually some of Arif's topics, which was pharma. And our partnership with EQRx is a partnership with a pharmaceutical manufacturer. And what they're trying to do is bring similar products to market to things that are already on the market, uh but do it at a dramatically um or radically lower price. And the way they're doing that is they look at areas that have little to no competition at the moment. So medications that don't have generics coming out. No biosimilars. They might not even have other branded medications in the space, or maybe there's two of them. And they'll partner with health plans like us to even identify some of those spaces, whether it's in oncology or it's in autoimmune, which are two two areas they are looking at, and then they will go out and search for molecules or drugs that they can bring to market quickly, uh to challenge those other medications.

And now that sounds like the opportunity of any drug company, but let me change that a little bit. They can they can bring down their price a little bit by already going after molecules that are somewhat known, so drugs that the clinical community community is aware of uh, and it's almost like a, we used to call this back in the day, it has a different connotation now, but back in the day, we used to call these "me too" drugs. Like, do we need another one of these? Do we need another one of these?

Well, EQRx is using that but slashing the price out from underneath. One way they're doing it goes back to Arif's commentary on the manufacturer's R and D budget, which they're shrinking because they are going ahead and looking at molecules they already know about, but then they're not going to advertise. They shrink that advertising budget really small by participating and partnering with health plans so that we use our networks of providers to communicate about these new drugs. So we're going to go out there and we're going to tell the oncology community in North Carolina, or more broadly, our broader network, that these products are available at dramatically lower prices. And so this will help just about everybody, actually. It's not just a plan-specific item. This is, everyone will be benefit from these lower-cost items, but the plan gets an extra um reduction in cost due to our partnership because we've gone out there and helped to market these drugs for them. These are going to be clinically effective uh and clinically safe, if not superior at times, to what's already on the market. So, one solution to that list price is just tackling it with a partner like a pharmaceutical company.

The next item you're seeing here is Audaire and Hemophilia, which is directly your your commentary on on the challenge of hemophilia patients. And that that challenge is that they have such a variability in the disease state, uh, not only person to person but within one person, they might use medications different from month to month. And those costs can be very very high. So in tackling that problem, we went out and looked for those pharmacies in our specialty network that had really good clinical acumen in handling hemophilia members and knowing their needs. And then shrunk that network down to just those that were experts in hemophilia, which gave us the ability to lower, not only the cost of the product itself, which is great, but changed the way that utilization was was being uh handled by partnering with Audaire. And Audaire uses a radio frequency code, basically a QR code like people are used to seeing at restaurants that pick up a menu or to scan to pick up a website, they're using that QR code on the medications that they're delivering to members so that they can scan it, determine how much they're going to use, and then that feedback goes back to the plan and Audaire, so if we see something that is peculiar, uh we can intervene with the provider. And we've already seen this working. Not only have we seen the unit costs come down with the network side of this, but we've seen that utilization can change when a member was over-utilizing on the acute side, the acute bleed side. And we notified the provider so they could intervene with a prophylactic method that would keep those bleeds down, which not only bettered the life of that patient, because they're not bleeding as much, but those prophylaxis treatments brought down the cost by not using so much acute treatment. So, a really cool partnership with both EQRx to tackle that list price and then Audaire and our Hemophilia Network to tackle a more specific uh disease state and specialty uh through the management with those QR codes that are pretty cool.

[Julie] That is cool. I’m uh excited to hear that we're using that technology for more than just uh the convenience of ordering concessions at the ball game.

[Joey] For sure.

[Julie] Um, I want to also just transition to the next slide, Joey, to kind of pull a little bit further on that thread of affordability.

[SCREEN TEXT] RX SAVINGS SOLUTIONS: Lower Cost Alternatives, Member and Plan Savings

MEDSYOURWAY MAIL: Amazon Pharmacy, Discount Card Pricing

SEMPRE HEALTH: Adherence = Cost Share

[Julie] This time, like, aiming it at our members. I think, you know now more than ever with everything that you're hearing about the cost of gas and food and everything else going up, you know affording drugs is also a big concern for a lot of our members and their families, and um is a big driver, honestly, of of medical debt. And uh some of the trends that we're seeing with bankruptcy, I was just reading about the other day, and understanding, you know, all of the bills that uh some of our members face with complex medical conditions and and such. So, would you be able to walk us through just some of the ways that we are targeting affordability from a member perspective?

[Joey] Yeah, these these solutions here are really cool. They all play in the in the sandbox together really well. They don't um send conflicting messages to our members. And the reason I say that is because they really do kind of come at several angles. Rx Saving Solutions, I like to tell people that it's a call to action that differentiates them from some of these other programs. Rx Savings Solutions will analyze claims data from our members, and they'll take a look at some of the transitions you can have within a formulary from, oftentimes, from one generic to another generic where that individual savings might not be a lot but they do add up over time. And so Rx Savings Solutions will reach out to a member via email or text message, or if it's a really high-cost opportunity, we'll send out some mailings, and they will let the member know that there's a savings opportunity and to log in to our single sign-on portal at Blue. And they can see not only the savings, the medication that's being offered as an alternative, but they offer a solution in which they can have Rx Savings Solutions notify the doctor or the provider, whoever's prescribing the medication, and say, "Hey, uh patients on board, what do you think? Do you want to switch to this medication?" And if that's done, that savings is right there for the member. So it's using some smart technology in the background of the claims to help members identify alternatives for themselves and then bring in the provider on that side.

Meds Your Way at mail, and I’m saying that specifically, at mail, because Meds Your Way is going to be a broader program for Blue, is a way to tackle discount cards. Uh everyone's kind of heard about Good Rx or Sav-On. You know I hear about this conflict every once in a while in which members will say, "Why is my cost lower at Good Rx?" And we could almost have a whole webinar on why that occasionally happens, but this is a solution for that in which, with Amazon Pharmacy as our mail program, they've agreed to have a discount card wrapped into the solution in which the member can uh have the opportunity to either use the discount card or use their benefit, whichever is cheaper for them. And then, that will wrap back into the accumulators for their out-of-pocket. So it goes towards deductibles. It goes towards the max out-of-pocket. And then we have a holistic view of what's going on instead of having this fragmented health care. And the member doesn't have to worry about, "Am I getting the best deal?" They'll know that we've integrated that discount card into a seamless process, with Amazon being a pretty awesome member experience, their their customer service is pretty pretty excellent. Same familiar Amazon experience most people have um you're going to see at the pharmacy, which are accredited pharmacies, I'll say that. Some people worry about, "Is this just a warehouse?" It's not. These are great accredited pharmacies uh that will be managing our patients just like other mail order pharmacies will.

SEMPRE HEALTH is our last one, and this one is tackling an issue around branded medications in chronic disease states like diabetes or asthma, cardiovascular disease, where there's no alternative in the generic space. And so these medications can be pretty expensive. And so what SEMPRE HEALTH does is they partner with manufacturers to basically say, "Can we have the coupon dollars that you'd be using elsewhere? And can we put them into our adherence program?" And so they will target specific medications that the health plan has said, "Yes, we're good to go on these. These are our preferred brands." They help with formulary adherence or formulary compliance, and then they reach out to members to enroll, and the program is run through text. That text will give them a dynamic discount at the pharmacy.

So, here's an example. A member goes to the pharmacy, uh shows them that they're with SEMPRE. It's all through text and they'll get a separate text that says, uh "Joey, your normal co-pay is 25 dollars but thanks for signing up with SEMPRE. It's now 20 dollars." They'll get their their prescription, and when it's time to fill the next month, they'll get a text message saying "It's time to fill your medication. When you do that on time, it'll be 15 dollars." And so they will encourage the member to come back on time because we know as you take these medications, you're more likely to stay controlled with your health and not have the damaging effects of diabetes down the road or damaging effects of asthma exacerbations that lead to the ER, or cardiovascular conditions that lead to heart attacks and stroke. And so SEMPRE drives up adherence by driving down cost share for members.

[Julie] Yeah, that's a win-win. I mean uh, you know, reminders alone are great, but when they're tagged to an incentive like that, I mean that's that's real money that adds up. And the other thing that I just wanted to punctuate is that Amazon, you know, Meds Your Way by mail with the discount card, is really exciting. That's been a real hard competition for us, especially with the the Good Rx. You know, now having a discount card be part of that I think is going to be really attractive to a lot of our groups.

[SCREEN TEXT] UTILIZATION MANAGEMENT 2.0

Oncology Pathways:

• Steering providers to the best clinical and most cost effective option while allowing freedom to choose
• Experts in the oncology space reviewing clinical policies and having peer to peer conversations with our providers

Autoimmune Pathways Coming in 2023: Partnership to create shared savings program with our providers to reduce overutilization and improve quality of care for members using biologics drugs for autoimmune disorders

[Julie] I’m going to move us along, Joey, just because I want to get to some questions. If folks have them, please put those in the Q and A box, again. But we would be remiss if we didn't talk about some of the newer strategies that we have around uh utilization management, and in particular those efforts targeting cancer and the growing number of autoimmune disorders. So, I’m intrigued to find out what what's new here, Joey? What are we doing differently?

[Joey] Yeah, so Utilization Management 2.0 is a really good way to put this because we can only write so many policies and have so many protocols that that stop people from prior authorization, or providers can can sometimes get frustrated with having to uh fill those out, instead, actually I shouldn't say instead, on top of those policies, we layer in what we're calling clinical pathways. And these oncology clinical pathways exist today with our partner, AIM, in which providers can put the disease state and the member information into a portal and it guides them through the most effective, safe, safest, and most cost-effective strategy for taking care of this patient. And if for some reason they do need to veer away from that that pathway I described, there are uh clinical experts, oncologists that are there for peer-to-peer support so that we know that we have experts talking to experts about that clinical care. So if they do something that is outside the standard guidelines for a member, it's being reviewed by a fellow oncologist to make sure that it's, again, safe and effective, and we also have that extra layer on there of making sure that all these providers know what the most cost-effective solution is in the oncology world.

Coming soon is Autoimmune, and it does a very similar thing only on top of it will incentivize our providers in a shared savings model in which we integrate into their clinical workflow. So when they're seeing a patient, they will see alerts that say, "This patient has been on Humira for so many days and is stable. Literature shows that you can actually taper down the medication at this point, which costs less and still get the same outcome." So that's a way in which we are doing very fine-tuned work within the clinical workflow of a physician already to manage the utilization and drive savings and maintain the clinical outcome that we're looking for. So it's 2.0 in that we have all those prior authorizations but we're getting deeper into refinement of therapies and how we can get those costs down through little tweaks in the regimen.

[Julie] That's great. And, Joey, that's for both um the benefit on both the pharmacy and the medical side for the Autoimmune Pathways? 

[Joey] Correct. Correct. That'll be both sides of the benefit as what's being reviewed.

[Julie] Okay. Good clarification. Thank you.

[SCREEN TEXT] HIGH COST THERAPIES

Problem: 

• $24B expected drug spend by 2024
• Annual price tag of >$300,000
• High cost drug approvals are increasing
• Clinical experts are few and far between

Solutions:

• Magellan: Complex medical and pharmacy benefit drugs cases with average annual costs >$300,000 reviewed by a specialty-matched physician
• High Touch Pharmacist: Retrospective review of our highest cost, most complex members by a clinical pharmacist

[Julie] Um all right and then lastly, um you know uh high-cost claimants are like a number one topic that I know my team is talking to uh with almost every single group. Um and, you know, drugs are not um exempt from driving some of those trends, in particular some of these really high-cost therapies and all that we've heard in the last couple of years about orphan drugs. I’m wondering if you can share a little bit more about that problem, so to speak. I mean, it's it's a good thing in the sense that they're finding therapies for rare conditions that we previously never were able to treat, but but what are some some ways that we're actually able to look at some of that spend and mitigate it?

[Joey] Yeah, like you uh I often have trouble saying it's a problem because it's a problem financially, but clinically it's a it's a wonderful thing. Finding new treatment treatments for patients that really had no option, uh seeing longer lives of things like cystic fibrosis and others. You can see a lot of the problem statement financially right there on the left. And actually, I'll say this anecdotally, I sit on a few different uh pharmacy and therapeutics committees that that review every quarter all the new drugs uh that have come to market. It used to be that there used to be one or two specialty medications. I think this past one, out of the 16 drugs reviewed, everything was specialty except for two. So we're talking, this is the space in which new drugs are coming to market. And they're they're in various disease states, very specific from a, very specific seizure disorder to um another, you know, Gaucher disease. I’m just thinking of these these items which there's only a handful of patients in the country and pharmaceutical companies have to recoup that R and D on just so many people. So the costs can easily exceed that that $300,000 mark. And our one of our solutions is bringing in experts to peer review experts. And that's what Magellan brings to the table is making sure we have specialty match physicians reviewing how these medications are used so it's not a general practice physician looking at the work of, say, a specialist in neurology. We want to get that neurologist to neurologist conversation going. It helps to uphold any denials that do come about this and ensure that policies are are maintained and holding the the best, most effective medications, safest medications with the right cost, altogether.

On the retrospective side, the flip side of that, we have a pharmacist uh reviewing medications that are coming in from both the medical and the pharmacy benefit, we call our high-touch pharmacist. that looks for claim interactions in an integrated uh data system that shows whether there's duplicate medications on the pharmacy benefit and the medical benefit, whether there's just incompatible drug therapies. And we've seen such things as a member taking a autoimmune drug IV and then taking an injection autoimmune drug on the pharmacy benefit, and the provider was unaware. So there's two sides to that story: One is uh the cost savings by saying we need to turn one of these off because these are thousands of dollars a month. And then the other side of it is, that's unsafe. And so, our pharmacist is catching those things on the back end. Then we're looking at those to create them prospectively in policies in the future so that they don't happen again.

[Julie] Wow, that is that's pretty hugely impactful. And I appreciate the examples, Joey. That helps break that down. I don't know where the 60 minutes went, but we are nearing the end of our webinar today, so I just wanted to share with the group some of the key takeaways.

[SCREEN TEXT] KEY TAKEAWAYS

• RX COST DRIVERS: Complex pharmacy ecosystem and supply chain
• PRICING CONTROL: Unregulated but we have levers to deploy
• INTEGRATION IS KEY: A holistic approach to manage total cost of healthcare

[Julie] Hopefully you found this information to be really valuable and interesting. Um you know three main things for you to remember that there are quite a few players in the pharmacy ecosystem. I think Arif used the word "middlemen" to describe three of them, but it begins with pharma manufacturers. It ends with payors like Blue Cross, and in between there's wholesalers, pharmacies, and PBMs.

Also that there's really no regulation on pricing right now, but there are some variables that we can that we can control. So, I’m thinking about some of the things we shared about formulary and um the networks and discounts. Those could be helpful.

And then, lastly, the most important thing for folks on the call today is to remember that integration is a really important part of the relationship between total cost of care and pharmacy, and that we at Blue are always looking at ways for us to balance clinical efficacy with cost and care coordination. 

I want to thank both of you for sharing some good intel on all of those key takeaways and also just let folks know that we do have additional information available to you at this website and some white papers and other solution briefs that you may find helpful to share with your own leadership or your various clients.

[SCREEN TEXT] FOR MORE INFO ... bluecrossnc.com/employer-solutions/pharmacy

I want to thank everyone for joining us today and sincerely appreciate your time and, uh, if you can, your feedback on the survey that's linked. Hope you have a great day and a good rest of your week. Take care.

[Arif] Thank you all.

[SCREEN TEXT] Adverse Reactions: Managing Pharmacy Trends & Cost Drivers 

THANK YOU

[SCREEN TEXT] What's New at Blue?

Hi. I'm Janece Brake.

[SCREEN TEXT] Janese Brake

Sr. Strategic Advisor, Market Planning & Performance

Blue Cross and Blue Shield of North Carolina

As the cost of health care continues to rise, we know many employers like you are looking for ways to make your health plan more affordable for your employees and your business.

[SCREEN TEXT] 20% of health care spending is pharmacy costs

Recent studies show that 20% of total health care spending is attributed to pharmacy cost.

[SCREEN TEXT] 12% 

Employers reports that specialty drugs alone account for 12% of this overall spend.

At Blue Cross North Carolina, we are dedicated to making prescriptions more affordable and accessible for every member. Not only do these efforts improve health outcomes for members, but they also make it easier for businesses to control pharmacy costs.

That's why we're introducing new, innovative ways to get your employees to get the medications they need with discounts they'll appreciate.

[SCREEN TEXT] Introducing MedsYourWay

MedsYourWay is a benefit design that gives every member access to easy online ordering for their medications, paired with a prescription drug discount card. Members can also compare their copay or cash price.

This card is not insurance, but when it's used for eligible and covered medicine, it counts towards the member's out-of-pocket maximums and deductibles.

[SCREEN TEXT] Savings up to 80%

Plus, they could see savings of up to 80%. And just like when you order your favorite products from Amazon, members skip the line at the pharmacy and have their prescription delivered right to their front door.

[SCREEN TEXT] Sempre Health

Another program to help control pharmacy costs is Sempre Health. Sempre Health targets members taking medication for certain chronic conditions like diabetes and respiratory diseases.

This program helps improve medication adherence and affordability at no additional cost to you or your employees.

It's easy to get started. Eligible members receive a personalized invitation to enroll in the program, and once they are enrolled, they automatically start saving on select prescriptions.

[SCREEN TEXT] Average savings of $230 a year

Members get text message reminders when it's time to refill their medications. The more they fill those prescriptions, the more their discounts increase each month.

When your medical and pharmacy benefits are combined, your business could see cost savings and better health outcomes. That's smarter, better health care.

[SCREEN TEXT] Visit BlueCrossNC.com/PharmacyInnovation to learn more.

Visit bluecrossnc.com/pharmacyinnovation to learn more.

[SCREEN TEXT] Blue Cross Blue Shield of North Carolina

Like most American families, the Bennetts have a monthly budget for things like groceries, a mortgage payment, and a movie night every now and then. But the rising cost of prescription drugs can seriously impact that budget.

[SCREEN TEXT] rxss Rx Savings Solutions 

Simplicity, Flexibility, Savings

That's why they use RX Saving Solutions through their Blue Cross and Blue Shield of North Carolina health plan.

Kimberly loves running around the playground, but her asthma doesn't. The price of inhalers came as a surprise. But when an RX savings notification came from Blue Cross North Carolina, it showed the Bennetts that a different brand came at a lower cost. Now Kimberly can continue ruling the playground.

[SCREEN TEXT] 67% of people who don't fill prescriptions say it's because of the cost

Tom's blood pressure medicine costs were so high, he almost stopped taking them. But when he received an alert about a more affordable generic medication, he talked to his doctor and started taking it the next day.

And when Joey's insulin costs increased, the online portal gave the family a way to compare pharmacies and find the insulin at a lower cost.

[SCREEN TEXT] rxss Rx Savings Solutions

RX Saving Solutions with Blue Cross and Blue Shield of North Carolina is keeping money in your pocket, so you're ready for every movie night.

Log on and start saving today.

[SCREEN TEXT] rxss Rx Savings Solutions

To get started, log on to BlueCrossNC.com/MyRxSavings today!

[SCREEN TEXT] Blue Cross Blue Shield of North Carolina