Independence Blue Cross has joined four other Blue Cross Blue Shield companies to form a pharmaceutical start-up called Evio Pharmacy Solutions that aims to contend with an expected wave of cell and gene therapies with prices that could top $1 million.
“We’re never going to argue that these drugs shouldn’t come to market,” said Brian Lobley, an executive vice president at Independence Health Group, IBC’s parent company. “We need to make sure that someone can actually afford to get them. That’s a problem.”
Lobley said the five insurers, which provide health insurance for more than 20 million people, will use Evio to look for ways to get drugs at a reasonable cost, make sure the medicines work, and then spread out the costs over time.
IBC’s partners in Evio, which is based in Denver, are Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, and Highmark Inc. The five insurers did not disclose the size of their investment in Evio.
The insurers’ move comes as the high cost of prescription pharmaceuticals has come under fire in Washington, where Congress is looking for ways to regulate prices. This month, the FDA approved a $56,000-a-year medication to treat Alzheimer’s, a decision that came under scrutiny because it has yet to be determined whether the drug improves patients’ health.
In May, a panel discussion at Cellicon Valley, an online conference on cell and gene therapy sponsored by Penn Medicine and Children’s Hospital of Philadelphia, covered some of the same issues Evio is meant to address.
The University of Pennsylvania Health System’s chief executive, Kevin Mahoney, suggested that manufacturers of hugely expensive cancer drugs could receive an upfront payment of, say, $500,000, but then return the money if the cancer returns. Insurers, health systems, and manufacturers could also devise contracts to spread the cost over time, Mahoney said.
That’s important because many people frequently change jobs, and thus insurance plans could impede the adoption of high-cost specialty medications, some of which may save money over time. It is difficult for an insurer or employer to pay $1 million for a treatment, only to see the long-term savings benefit a subsequent insurer, Mahoney and others said.