Blues Plans Pharmacy Solutions Venture Evio Targets Outcomes-Based Drug Contracts

Five of the most innovative Blue Cross Blue Shield Plans are joining forces to invest in a new pharmacy solutions venture called Evio. Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark Health and Independence Blue Cross are investing in a new independent company, Evio.

Evio will work to improve medication affordability and patients’ clinical outcomes and medication experiences. The five plans in total provide coverage to more than 20 million members across the United States.  

Initially, Evio will offer services to each of the five investor health plans to complement other innovative medication services the health plans offer. At launch, core focus areas for Evio are:

• Using evidence and data from real patient experiences to ensure the right medication gets to every patient, where, when and how they need it. Evio will have the real-world evidence to show how a drug is actually performing for patients in their own context, across the drug’s indications, different patient types and combinations of other comorbidities.
• Developing new, and enhancing existing, partnerships that leverage the innovation happening in the pharmacy and broader healthcare, technology, and analytics sectors today — to improve affordability, outcomes, and experience for patients. Evio will help those innovations get to more patients and integrate those solutions with what the health plans are already doing for patients.
• Continuing the evolution toward value-based care and enhancing outcomes-based contracting in the pharmacy space, especially on high cost drugs.

Of the five Blues plans, Highmark has the most experience in establishing outcomes-based contracts with drug makers. Within the last year, Highmark Highmark:

• Entered an outcomes-based agreement with AstraZeneca for Fasenra, an add-on prescription maintenance treatment for patients age 12 or older with severe asthma. Approximately 500 Highmark members utilize the healthcare professional administered formulation of Fasenra. This agreement monitors commercial and Medicare members.
• Entered an outcomes-based agreement with UCB, Inc. for its medication CIMZIA® (certolizumab pegol). CIMZIA is a tumor necrosis factor blocker that is prescribed for adult patients with chronic inflammatory conditions that include Crohn’s disease, plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, non-radiographic axial spondyloarthritis, and ankylosing spondylitis.

Now, instead of continuing on its own, Highmark is joining with the other Blues plans to leverage the combined membership while negotiating potential contracts with greater insight from a larger group of patients.

Takeaway: Implementing a potential Evio solution may be a challenge for the five Blues plans