By David Wenner, PennLive
Health insurer Highmark said it has partnered with a new company that uses data and software to match people to specialty pharmacies that provide drugs for complicated conditions such as cancer and multiple sclerosis.
Specialty drugs are known for being very expensive. While they are used by only a small fraction of Highmark customers, they account for nearly half the $5 billion per year Highmark spends for prescription drugs, according to Sarah Marche, Highmark’s senior vice president for pharmacy services.
They also are known for being problematic for patients and their doctors, who sometimes struggle to find a specialty pharmacy that provides the needed drugs and services at a reasonable cost, said Joe Cardosi, the CEO of Free Market Health.
Pittsburgh-based Highmark has bought a minority stake in Free Market Health, which Cardosi founded a few years ago in Pittsburgh.
Cardosi says his company uses new technology and data about Highmark members to match them to a specialty pharmacy that best meets their needs. It also can allow specialty pharmacies to bid for customers, allowing free market forces to drive down costs, according to Cardosi.
Officials for both companies say Free Market Health can give people covered by Highmark access to more specialty pharmacies, drive down costs, and ensure better value and quality.
“The existing specialty drug ecosystem really fails in what it’s meant to do, with is efficiently deliver life-saving and life-altering medications into the hands of patients,” Cardosi said.
Highmark’s Marche said “we are going to match the patients to the best specialty pharmacy that’s going to meet the needs of the patient.”
Free Market Health, which is a for-profit company, gets its income from charging an administrative fee, according to Cardosi.
As it stands, the new program is available to some but not all Highmark customers, officials said on Tuesday.
It’s presently available to Highmark’s commercial members, which refers to people who have Highmark coverage through their job. Highmark is the process of offering it to companies which are self-insured. These companies choose their own sets of benefits and pay for the care, with Highmark handling administration.
Highmark eventually plans to include it in coverage sold to individuals through avenues such as the electronic health insurance marketplace and government-sponsored Highmark coverage, although that will happen in “future years,” according to a spokesman.
Marche cited obtaining government approvals as one of the reasons Highmark doesn’t immediately offer the new specialty drug program to everyone with Highmark coverage.
Cardosi said Free Market Health will operate as “an unbiased third party” and won’t enter into agreements that obligate it to steer customers to certain specialty pharmacists.
“Our absolute goal is to create a fair marketplace,” he said.
Marche said it’s too early for Highmark to know specific savings for customers.
Cardosi said he attended Duquesne University in Pittsburgh and launched Free Market Health about three years ago. It’s based in Pittsburgh’s Strip District and has about 40 employees, he said.
Read the story on PennLive.