MANAGING COMPLEX CONDITIONS
Specialty drug costs are on a meteoric rise, now exceeding 55% of total drug spend.1 What’s more, 35% of total drug spend is driven by medical drug spend.2 Integrated solutions and strategies – across both medical and pharmacy benefits – help you successfully navigate the complicated and evolving specialty landscape.
INTEGRATEDRX™ – ONCOLOGY
Cancer patients, caregivers benefit with integrated clinic-to-pharmacy care
Streamline the treatment pathway for employees fighting cancer, helping them get their oral oncolytic and companion medications directly from their oncologist’s clinic or affiliated hospital pharmacy.
“It’s really designed to bring the pharmacy and the physician closer together to the patient.”
Marci Conlin, Vice President, Pharmacy Network Management
Watch story
Biosimilars
Helping to lower drug costs with biosimilars
Make sure your employees have access to the best treatments. Biologic drugs are changing lives for the people who need them – but often at a very high cost. Horizon Pharmacy + Prime promote the use of evidence-based biosimilar drugs that may cost up to 35% less while delivering the same outcomes.3
FLEXACCESS™
Greater savings potential, ease and expanded pharmacy options
This copay assistance solution uses Prime’s channel-independent model to give your employees the best available discount when they get their higher-cost medicines. Not only can your employees see copays as low as $0, they’ll also be able to get their medicines from a wider network of pharmacies, including specialty and retail locations.
FlexAccess is only available for self-funded groups.
Split fill
Less waste, more savings opportunities
Certain high-cost medications may cause adverse side effects. For these medications, Prime provides a split, or partial, fill prescription with a prorated copay to align with the number of pills dispensed. This gives your employee the opportunity to try a medication to determine the existence and severity of side effects before continuing therapy, potentially saving money and reducing waste.
SITE OF CARE
The right care in the right setting
Hospital outpatient facilities can be two to three times more expensive than other sites of care for infused drugs. With Site of Care, your employees will have the convenience of receiving a select list of infusible drugs in the convenience of their home, a local infusion center or their provider’s office.
Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey.
1 IQVIA Institute for Human Data Science. (2022, April). The use of medicines in the U.S. 2022. https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/the-use-of-medicines-in-the-us-2022/iqvia-institute-the-use-of-medicines-in-the-us-2022.pdf
2 Pharmaceutical Strategies Group, LLC. (2022). 2022 Artemetrx® state of specialty spend and trend report. https://www.psgconsults.com/specialtyreport2022
3 Biologic Medicines: The Biggest Driver of Rising Drug Prices. (2019, March 8). Forbeshttps://www.forbes.com/sites/theapothecary/2019/03/08/biologic-medicines-the-biggest-driver-of-rising-drug-prices/?sh=37c36b0718b0