Health insurer is first to cover all specialty medications under a single medication benefit
(PORTLAND, OR) -- Rapid developments in the pharmaceutical industry have led to a steady increase in the use and cost of “specialty” medications to treat chronic conditions such as arthritis and psoriasis. This has led to some inappropriate selection of these medications, higher overall drug costs and medication coverage being spread over both pharmacy and medical benefits. Regence has introduced a new solution with Medication Cost Integration (MCI), which covers all medications under a single medication benefit. MCI is now available as part of the company’s new self-insured suite of services, Integrated Health Solutions.
“The growth of specialty medications has challenged health insurers, because we now have options that fall under both medical and pharmacy benefits. This meant widely differing co-pays, inconsistent member financial responsibility and more confusion for members and providers. Medication Cost Integration blends medication coverage into one benefit, with the same co-pay for different versions of a medication used to treat the same disease or condition,” said David Clark, vice president of Pharmacy Services and president of RegenceRx. “Whether they receive their medication at a pharmacy or a physician’s office, members can still get the treatment they need with medications that provide the best overall value.”
About Medication Cost Integration
Specialty medications are high-cost injectable, infused or oral medications that are used to treat chronic conditions, including cancer, arthritis, psoriasis and multiple sclerosis.
The MCI formulary is divided into a standard and extended 3-tier formulary. How much the member pays for a medication depends on where it falls on the formulary. The Standard 3-Tier Formulary is similar to today’s formulary, in that it covers all lower-dollar and most self-administered orals, topicals, suppositories, diabetic supplies and similar prescribed items. The Extended 3-Tier Formulary is comprised of three additional tiers for high-cost self-injectables, specialty, limited distribution products, cancer products, and medical medications/infusions.
The development of MCI was inspired by the results of Regence’s own original research. The study showed that members who had medical-only benefits experienced a significantly higher increase in overall medical expenses than those with both medical and pharmacy benefits, and this unnecessarily increased the rate of medical claims cost growth. Regence concluded that an integrated medical and pharmacy benefit may enable plans to significantly slow claims costs and improve price transparency access to the information members need to manage their overall health care costs.
RegenceRx, one of the nation’s few not-for-profit pharmacy benefit management groups, is a wholly-owned subsidiary of Regence. RegenceRx focuses on clinical evidence when building our list of preferred medications. The focus on lower net costs has saved Regence and our customers more than one billion dollars over the past 10 years.
Regence is the largest health insurer in the Northwest / Intermountain Region, offering health, life and dental insurance. Regence serves more than 2.5 million members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (selected counties in Washington). Each health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Regence is committed to improving the health of our members and our communities, and to transforming our health care system. For more information, please visit www.regence.com or follow us on Twitter.