New specialty drug program improves affordability for groups and members

Providers often add markups onto certain specialty drugs they administer, and unfortunately those markups can become a huge cost for members and employer groups. Specialty drug markups may average more than 200% and vary from provider to provider. We’ve seen one drug’s markups range from 10% to 400%.
To limit these excessive markups and to help control costs for our members and employer groups, we’ve launched an innovative new program called LevelRx.
How LevelRx works
We’ve negotiated with certain providers within our network to be part of the LevelRx program. Members who are part of the program have their specialty drugs administered by a participating provider. These providers agree to be reimbursed for administering a select set of specialty drugs based on a sustainable and consistent fee schedule.
How is it going?
We launched LevelRx for commercial members and some employer groups in Idaho and Utah on Oct. 1, 2024. Implementation has gone smoothly, and we’ve provided ongoing care coordination and support for the few members who’ve had to switch to a participating provider for the administration of their drugs. LevelRx is already delivering savings which we expect to add up to millions of dollars by the end of 2025. We’re working to expand the program throughout our service area in the coming years.
“LevelRx goes to the heart of what it means to make health care easier and lives better for our members,” says Pharmacy Clinical Program Director Danny Wallenslager. “By tackling the complex world of specialty medications, we’re not just reducing costs but also giving members more access to medications that can enhance their quality of life.”
LevelRx is just one part of our strategy to address the high costs of specialty drugs. Other efforts include encouraging members to have specialty drugs administered at less expensive locations, as well as negotiating with drug manufacturers and pharmacies for better prices for our members.