Highmark is offering a look at where it's seeing success in a specialty pharmacy partnership with Free Market Health.
The insurer said in an announcement Wednesday that through the program, it saw access rates for individuals taking a specialty drug for the first time that are 50% higher than those who were not participants in the care management program.
In addition, people in the program got their first fills of a specialty medication more quickly, according to the announcement, between two and four days faster on average compared to those who aren't in any care management program or are in a different specialty pharmacy offering.
Highmark said the program is being utilized across most of its book, including Medicaid, employer-sponsored plans and Affordable Care Act exchange coverage. Close to half of its self-funded employer clients are using the program, according to the announcement.
Through Free Market Health's platform, specialty medication referrals are linked with specialty pharmacies that can support the member's individual needs while accounting for quality and cost. There are about 500 drugs available through the program, according to Highmark.
Under the program, participating specialty pharmacies are incentivized to conduct social determinants of health assessments for high-risk patients. These members are then referred to social workers through Highmark to manage their social needs, closing a key care gap, according to the announcement.
The program also aligns with Highmark's work with CivicaScript to expand access to new, lower-cost generic medications, the company said.
Sarah Marche, senior vice president of pharmacy for Highmark, said in the press release that about 30% of the insurer's overall healthcare spend goes to pharmacy costs. Within that, about half of pharmacy spend goes to specialty pharmacy.
"Our specialty drug management program enabled by the Free Market Health technology platform enhances specialty prescription drug access and adherence and care pathways for members with complex health conditions," Marche said. "With fewer episodes of drug abandonments and lower claims costs for medications, members and group customers both benefit.”
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