New Company to Focus on Value-based Pharma Contracts

Five Blue Cross plans have launched a new company, Evio Pharmacy Solutions, that will create solutions to improve medication affordability and patient clinical outcomes. The five plans—Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark Inc., and Independence Blue Cross—in total provide coverage to more than 20 million members across the United States.

The new company is based in Denver and will look to use real-world evidence to create new clinical insights and focus on value-based care and the alignment of payment with outcomes, Hank Schlissberg, Evio’s president and CEO, said in an interview. “We have access to very unique data because it is the intersection of pharmaceutical and medical. The health plans have real-world evidence of how a drug is performing in the real-world.”

Schlissberg said Evio will create its own analytics systems that will leverage the five plans’ claims data but will also look to partner with other analytics and solution providers. He expects the solutions will operational later this year or early in 2022.

“The things that will be most interesting to us is anything that provides greater transparency to patients and providers, anything that provides clinical information, anything that reduces the overall cost of how a drug gets to a patient, and anything that creates a simpler or easier experience for patients,” he said.

The ability of Evio to access data from the five Blues plan gives Evio a unique view of health care and medication use, Schlissberg said. “We have the ability, for example, to see how a drug performs in the real world based on whether it actually improves labs or other tests or whether it keep patients out of the hospital. These are critical indicators of how a drug performs in the real world that is different from how a drug is evaluated in a clinical trial.”

Insight into real-world performance will become even more important, he said, because of high spending on prescription medications, which is mostly driven by specialty pharmaceuticals. CVS Health and Evernorth (parent company of Express Scripts) both report that specialty drugs now account for more than half of total drug spend.

“Prescription costs are rising and are astronomical. In most cases, they are over 30% of the overall medical spend,” Schlissberg said. “The affordability challenge is there.”