Five Blues plans launch Evio, a for-profit company focused on lowering drug prices

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Five nonprofit Blue Cross Blue Shield plans have stepped forward to create a new independent, for-profit pharmacy solutions startup called Evio, the plans announced today.

The goal of the new organization is to improve medication affordability, as well as patients' clinical outcomes and medication experiences. Initially, Evio will offer services to each of the five investor health plans to complement other medication services those plans offer.

The five plans – Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark Inc. and Independence Blue Cross – provide coverage to more than 20 million members in total across the U.S.

WHAT'S THE IMPACT?

Evio will have a number of core focus areas upon launch. One is to use evidence and data from patient experiences to ensure the right medications reach the right patients. According to the Blues plans, Evio will have evidence at hand to show how a drug is performing for patients in their specific contexts, across the drug's indications, different patient types and combinations of other comorbidities.

Another goal for the new venture will be developing new partnerships and enhancing existing ones that leverage current innovation taking place in the realms of pharmacy, healthcare technology and analytics.

This, the groups said, is intended to improve affordability, outcomes and the patient experience. Evio's stated mission is to help innovations reach more patients, and integrate those solutions with what the health plans are already doing.

Ultimately, the Blues plans hope this will continue the evolution to value-based care, and enhance outcomes-based contracting in the pharmacy space, especially as it pertains to high-cost drugs.

The amount of funding provided by the Blues plans was not disclosed.

THE LARGER TREND

The rising cost of prescription drugs has become a very real problem in the U.S. The net cost of prescription drugs – meaning sticker price minus manufacturer discounts – rose more than three times faster than the rate of inflation over the course of a decade, according to a 2020 study published in JAMA.

That tracks with other research on the topic. After reviewing tens of millions of insurance claims for the country's 49 most popular brand-name prescription drugs, a team from Scripps Research Translational Institute found in 2019 that net prices rose by a median of 76% from January 2012 through December 2017 – with most products going up once or twice per year.

Meanwhile, a drug-cost survey published in 2019 found that unfilled prescriptions remain a problem, with 73% of physicians taking the patient's responsibility for cost into account in making a prescribing decision. Almost as many physicians, 70%, said they believe the high cost of prescribed medications leads to unfilled prescriptions.

In April, millions of Blue Cross and Blue Shield beneficiaries received notices that they may be eligible for a share of a $2.7 billion antitrust settlement that was settled last October. Claims must be filed by November 5.

The settlement resolves claims that the insurers violated antitrust laws by entering into an agreement not to compete with each other and to limit competition among themselves in selling health insurance, according to the BCBS settlement website.

ON THE RECORD

"Evio has a real opportunity to change the trajectory of pharmacy costs, improve clinical outcomes and make it easier for patients to access the medications and treatments they need," said Sandra Clarke, Evio board chair and chief financial officer of Blue Shield California. "We are investing in this innovative venture as part of our ongoing efforts to reduce costs and improve patient experience, and we will continue working alongside our local providers to achieve these goals. We're excited to have a healthcare veteran of the caliber of Hank Schlissberg, who has 20 years of expertise in healthcare strategy, operations, and growth, join us as CEO."
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com