Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Support Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services Register for Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Back
Blue Cross NC Introduces New Autoimmune Pathways Program June 07, 2023 Pharmacy Physicians & Specialists

Medications used for rheumatic diseases are now the number 1 contributor to the specialty drug spend. Six of the top 10 specialty drugs with the most spend are for rheumatic diseases. 

For this reason, starting July 1, 2023, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement the Autoimmune Pathways Program through program vendor Outcomes Matter Innovations (OMI) with the goal of preserving outcomes and reducing costs for members with chronic inflammatory disease. 

Blue Cross NC in-network rheumatologist providers will now have the opportunity to utilize a web-based machine-learning technology platform operated by OMI that suggests evidence-based care pathways. 

This shared savings program will address provider use of these high-cost specialty drugs for patients with rheumatoid arthritis or psoriatic arthritis and will allow high-cost specialty drugs to be utilized efficaciously for better outcomes as well as reduced medical expenses. 

The program will seek to support members remaining on their non-biologic medication as long as clinically appropriate prior to switching to a more expensive biologic medication. For members who are taking a biologic medication, the evidence-based care pathways encourage dose tapering or a medication holiday if the member is in remission or showing low disease activity. 

OMI may reach out to you to facilitate contracting, onboarding and training prior to and ready for the July 1, 2023, go-live date. 

For any questions, please reach out to OMI at support@omimanagement.com or call the Rheumatology Division Dedicated Support Line at 201-839-2266.