Member Login

Anthem, St. Elizabeth Partner to Address Drug Costs in NKY

Anthem Blue Cross and Blue Shield announced Tuesday that it is collaborating with St. Elizabeth Healthcare to limit costs of specialty drugs in Northern Kentucky.

Through the program, St. Elizabeth will limit the price it charges for hospital-administered specialty medications typically used to treat cancer, autoimmune disease, and other complex conditions to the cost of the drug plus a small fee to cover storage and handling, the announcement said.

It is common practice for hospitals across the country to mark-up the price they charge by 200-300 percent above their cost to purchase the medication, and in some cases as much as 500 percent, the announcement said. These medication charges are typically separate from and on top of charges for the medical staff time and equipment needed to administer the medication.

Anthem Blue Cross and Blue Shield in Kentucky Medical Director Jeff Reynolds, M.D. says excessive hospital mark-ups on top of the extremely high cost of the drugs themselves have driven specialty drugs to represent about 45 percent of all drug spending despite being only two percent of all drugs prescribed. He notes this trend is expected to accelerate to 52 percent of all drug spending by 2024.

These fast-rising prices are putting enormous cost pressure on health care consumers and their employers, especially those employers that pay directly for their employees’ medical bills, the company said.

“St. Elizabeth’s partnership to reduce costs for Anthem members and their employers by limiting their mark-up for specialty drugs is a great example of how collaboration between health plans and health care providers opens the door to better care at lower cost for the communities we serve,” said Reynolds. “For many years, St. E’s has been a wonderful partner in assuring affordable access to care in this region.”

The two organizations two years ago announced a cooperative effort to protect employers from ‘shock’ health care claims – exceptionally high-cost and unforeseen health events that can have devastating impact on employers’ health care costs.

“St. Elizabeth is proud to work collaboratively with Anthem as we look for new and better ways to serve our community,” said Bill Banks, vice president of managed care at St. Elizabeth Healthcare. “Helping our patients and their employers deal with high-cost claims is a part of our mission, and we’re glad to have a partner like Anthem who is similarly committed to that effort.”

-Staff report