The competitive difference of BlueAdvantage Pharmacy Services

BlueAdvantage Pharmacy Services protects your bottom line and enables a better coverage experience for your employees and their families. Because of our thoughtful, expert formulary review and coverage practices, your organization can offer invaluable coverage that meets the medical needs of your employees and their families at sustainable prices, often avoiding the unnecessary cost bloat of high-priced drugs.

Stringent criteria

BlueAdvantage approaches formulary management differently than others in the market currently do. We analyze all the drugs that come to market for clinical effectiveness compared to other alternative and economic factors, then we set evidence-based criteria that limit increased costs for groups.

For example, semaglutide is an A1C-reducing GLP-1 drug FDA-approved as Ozempic for people with type 2 diabetes, and as Wegovy for obesity. The drugs cost around $12,000 annually. To prevent GLP-1 diabetes drugs including Ozempic being mis-prescribed for weight loss in members who do not have diabetes and for plans who do not cover weight loss medications, our custom formulary assures that only those with type 2 diabetes receive the treatment.

And it works. Applying these strict criteria that exclude GLP-1 coverage for weight loss saves our employer partners millions of dollars.

The hidden costs of rebates-driven strategies

Our competitors chase brand-name rebates, touting their high dollars saved in manufacturers’ rebates for expensive drugs. But the high-cost, brand name drugs are not necessarily more effective for the patient than lower-cost alternatives. When rebates drive your savings, groups have to spend more to yield more savings.  Often, PBMs will encourage the use of high-cost brand drugs even when lower-cost therapeutic alternatives are available and equally or more effective.

A well-managed formulary may not deliver the highest rebates.  The expert formulary review we apply to every drug means we can often circumvent the need for those high-cost drugs altogether while still meeting your members’ clinical needs. That’s a competitive distinction for us because removing high-cost, low-effectiveness medications is the most significant way to reduce your pharmacy spend.

Expert drug review

Our approach, first and foremost, protects your members by ensuring the right patient receives the right drug at the right time.

Our formulary covers drugs that deliver high-quality clinical outcomes for your members. Key factors we consider when evaluating adding new and existing drugs to our formulary include:

• Safety relative to other drugs with the same indications and therapeutic actions
• Efficacy relative to other drugs with the same FDA-approved indications
• Available dosage forms of the drug
• The dosing interval for each approved indication

As the standards of practice change and new information becomes available, we reevaluate products on our formulary for continued inclusion or removal. We also reevaluate economic factors. For example, we prefer lower-WAC insulin products and biosimilars vs. high-cost options with higher rebates, providing real-time savings to members and plan sponsors.

For example, Humira is an immunosuppressant used to treat many inflammatory disorders and can cost more than $6,000 per month with standard dosing. But when its patent expired and biosimilars became available, BlueAdvantage began redirecting prescriptions to viable alternatives that cost nearly 30% less with the same clinical efficacy.’

To learn more about our pharmacy services for your members and review BlueAdvantage formulary lists, visit BlueAdvantage Pharmacy Services.

 

 

SPECIAL NOTE: The above notice is intended solely for informational purposes and should not be relied upon as guidance or advice with regard to any drug, therapy or treatment, nor with regard to its safety, efficacy, applicability or appropriateness for any person or Plan participant. BlueAdvantage does not offer medical or legal advice or services to its health plan customers or their individual Plan participants or beneficiaries. Any estimate stated with regard to potential impact for your health plan, including but not limited to any estimated number of Plan participants/beneficiaries potentially affected, is purely an estimate and should not be relied upon for business, financial or Plan administration purposes. Additionally, Plan benefit design and ultimate authority in regard to Plan coverage or benefits decisions, including but not limited to Plan coverage or non-coverage of any drug, therapy or treatment, remains the exclusive province of the Plan Administrator and/or Plan Sponsor, not BlueAdvantage.