Sandra Clarke on Transforming Healthcare Through Key Partnerships | California Blue Shield

Sandra Clarke

At Blue Shield of California, we continue to create value for our members through our ambitious plan to transform a dysfunctional healthcare system into one worthy of our family and friends. As COO, I know that we cannot drive significant system change and innovation alone. That’s why we invest in key strategic partnerships that focus on reducing costs and supporting our member experiences, as well as driving change across the system.

Our pharmacy team, and the Pharmacy Care Reimagined work within it, is focused every day on how to reimagine the prescription drug experience. We believe that every patient should have safe, affordable and appropriate access to medicines. This means constantly evaluating and challenging the status quo to ensure that all parts of the system deliver real value.

Invest in partnerships to drive innovation

Blue Shield of California is working on several market-based partnerships. We invest in companies that aim to make prescription drugs more affordable by increasing price transparency and measuring their effectiveness.

Whenever we evaluate an investment or partnership, it is important that we consider member benefits and the best uses of Blue Shield of California resources. We still expect fair financial returns for these companies in addition to a tangible impact on the cost and quality of healthcare. Three of Blue Shield’s major investments include:

CivicaScript. California’s Blue Shield has launched an initiative to launch CivicaScript, a nonprofit pharmaceutical company dedicated to reducing the price of outpatient medications. Blue Shield joined over a dozen other Blue plans in 2020 to invest a total of $55 million in CivicaScript. The goal is to partner with manufacturing partners to bring more affordable generic drugs to non-competitive markets.

Our investment in CivicaScript is important because it helps address high drop-out rates, which is when patients stop using their prescribed medications because they were too expensive or because they ran out of them. enough of asking their pharmacist to call their doctor for less expensive alternative medications.

In August, CivicaScript launched its first drug, abiraterone acetate, a generic drug used to treat prostate cancer that has spread to other parts of the body. The maximum drugstore recommended price of $171 a bottle is about $3,000 less per month than current drug costs.

Blue Shield also partnered with Civica to announce funding to develop and distribute insulins at a significantly lower cost than current drugs. Civica plans to set a transparent recommended consumer price of no more than $30 per bottle. This is another example of how Blue Shield is working to disrupt the drug market for the benefit of our members and the entire healthcare system.

Evio pharmacy solutions. Blue Shield of California invested last year in Evio Pharmacy Solutions, a startup that uses a data-driven approach to controlling drug costs. The company aims to help its investors’ health plans by improving drug affordability, patient experience and clinical outcomes. Evio uses evidence and data from real patient experiences to show how individual drugs work for patients in their own context, across drug indications, different patient types, and combinations of other comorbidities. Four other Blue Cross and Blue Shield health plans also fund Evio.

Our investment in Evio offers a real opportunity to change the trajectory of pharmaceutical costs, improve clinical outcomes and make it easier for patients to access the medicines and treatments they need.

Gemini Health. In 2019, Blue Shield of California funded Gemini Health, a San Francisco Bay Area company that provides real-time patient-specific benefit, formulary, and cost information on prescription drugs to prescribers at multiple points of care, including patient-physician visits. The goal is to give prescribers useful information about drugs and potential lower-cost options, so they can discuss clinically appropriate alternatives with their patients. The investment resulted in savings of over $20 million in drug costs in the first two years of the initiative.