STAT+: Blue Shield of California overhauls drug pricing operation — by adding more vendors
STAT spoke with Blue Shield of California’s chief operating officer about the company’s new drug pricing arrangement.
Blue Shield of California, a health insurance company that covers almost 5 million people, is restructuring how it will pay for prescription drugs by dividing the work up among five different vendors — two of which include Amazon and Mark Cuban’s pharmacy company.
Starting in 2024, Blue Shield will rely less on CVS Health’s pharmacy benefit manager, CVS Caremark, a move that led Wall Street to sell off CVS’ stock by more than 9%. Blue Shield hailed the new model as a “milestone” for “today’s broken prescription drug system.” But details remain ambiguous, and the insurer is still incorporating many of the same players that are major parts of that system.
To be clear, Blue Shield is not abandoning CVS, which owns one of the most dominant PBMs in the country. CVS will still fill and manage prescriptions for Blue Shield members who need “specialty” drugs, which typically cost a lot of money and require special handling. When asked what percentage of Blue Shield’s total drug spending is absorbed by specialty drugs, the company’s chief operating officer, Sandra Clarke, told STAT it was “less than 50%, but it’s a whole lot more than a small amount.”
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