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2020-02-12 Feldman Statement on BCBST Policy

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Statement from CSRO President On New BCBST Policy

Posted: February 12, 2020

Schaumburg, IL — Following a press release issued by BlueCross BlueShield of Tennessee (BCBST) attacking the Coalition of State Rheumatology Organizations (CSRO) for exposing a policy that will prove to harmful to patients, CSRO issued the following statement:

“It is absolutely shameful how (BCBST) is misleading physicians and patients about its dangerous new prescription policy. In its recent press release the insurer did gymnastics with the truth about its impacts to patients.

BCBST decision makers must realize that by removing the ‘buy and bill’ system, the added expense and logistics burden placed on doctors will prevent them from being able to infuse patients in their offices. To suggest otherwise is pure fantasy.

The new BCBST policy moves the acquisition of these administered medications away from the physician to the patient’s pharmacy benefit through specialty pharmacy.

In BCBST’s attempt to differentiate 2 middlemen, specialty pharmacy and pharmacy benefit managers, in its statement — it made a distinction without a difference. The ‘straw man’ arguments made does nothing to change the verifiable fact from the Centers for Medicare and Medicaid Services (CMS) dashboard. The most recent dashboard clearly shows that prices of Part D medications, those managed through a pharmacy, rise at much faster rates than physician “buy and bill” Part B medications.

When comparing several of the same rheumatologic biologics (Orencia, Actemra, Simponi/Simponi Aria) dispensed through both specialty pharmacy (Part D - self injectable ) and “buy and bill” (Part B- provider administered), the change in average spending per dosage unit over 2017-2018 was always higher in the Part D version. In the case of Simponi and Simponi Aria the Part B version dropped more than 5% while the Part D version increased more than 10% during that time period.

BCBST calling these facts ‘false’ does not change the reality. We see every day how the PBM industry is causing the rise of prices for prescription drugs. This new policy from BCBST will do the same and decrease patient’s access to getting their medication administered at their doctor’s office.

Physicians are on the front lines of medical care. We see the struggles and confusion that that insurers put doctors and more importantly their patients through — they deserve better — they deserve the truth — not a dangerous profit motivated policy.”


To schedule an interview with CSRO, please contact Dan Rene at (202) 329-8357 or daniel.rene@kglobal.com