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Inflammatory Bowel Disease Management: How We’re Making a Difference

Inflammatory Bowel Disease (IBD), which includes Crohn’s disease and ulcerative colitis, affects millions of people worldwide. In the United States alone, it is estimated that between 2.4 and 3.1 million adults are living with IBD with the total annual U.S. health care costs being about $8.5 billion. Managing these chronic conditions often requires lifelong treatment with expensive biologic medications.  

IBD can significantly impact individuals’ ability to participate fully in work and social events. The unpredictable nature of the disease often leads to increased absenteeism and reduced productivity. This not only affects the individuals but also places a stress on employers due to lost productivity and the need for workplace accommodations. 

As the cost of these drugs continues to rise, our health plan plays a critical role in managing these expenses for both employers and members. Here’s how we are helping control the costs of specialty medications and create better outcomes for our members: 

Bringing the benefits of pharmacy and medical care together. 

Medical and pharmacy care are part of a complete approach to health, and we are uniquely positioned to bring them together, providing holistic and coordinated care – and proven benefits. 

Supporting Your Bottom Line 

Our full suite of pharmacy and medical strategies can support those with IBD, offering innovative solutions for better outcomes and bottom lines. 

  1. Formulary Management: We use an indication-based formulary where preferred drugs are unique to specific inflammatory conditions. 
  1. Utilization Management Strategies: All inflammatory specialty drugs, with one exception, require prior authorization. Even preferred biologic therapies require an appropriate diagnosis and standard of care before approval. 
  1. Specialty Drug Benefit Optimization: For drugs that cross over medical and pharmacy benefits, our policies drive utilization to the most cost-effective benefit when reasonable. 
  1. Site of Care*: For inflammatory therapies that must be administered by a health care professional (e.g., Entyvio, Inflectra, Remicade, Simponi Aria), we offer a Site of Care program that engages members receiving infusions at high-cost facilities and offers home infusion for convenience and savings. 
  1. SaveOnSP Pharmacy Specialty Copay Assistance Benefit*: Provides an innovative specialty coinsurance assistance service offering financial relief to employers and their employees for certain specialty prescription drugs. This program targets 200+ specialty drugs spanning some of the costliest specialty therapeutic classes, including inflammatory. 
  1. HelpScript Medical Specialty Drug Copay Assistance Benefit*: Helps reduce out-of-pocket costs for medical benefit specialty drugs targeting some of the costliest specialty therapeutic classes, including inflammatory. 
  1. Biosimilar Optimization: We are proud to be a leader in leveraging biosimilars and supporting access, affordability, and medication adherence. We include biosimilars in all ten drug categories in which a biosimilar is available, including biosimilars for Remicade and Humira. 
  1. SafeGuardRx: Program which provides savings from drug manufacturers for certain early discontinuance credits and other cost management programs focused on some of the costliest therapy classes. 

People Come First 

Employees with IBD have care available that’s built just for them. Combining pharmacy and medical means we can tailor our approach to each individuals’ specific needs – assessing the whole person to develop a personalized care plan. 

ThriveWell in partnership with Personify Health* 

ThriveWell is a digital home base dedicated to engaging teams in health and wellbeing. Our partnership with Personify Health will give employees the tools to make small, everyday changes to their wellbeing that are focused on the area they want to improve the most. They’ll build healthy habits, have fun with friends, and experience the lifelong rewards of better health and wellbeing. 

Through ThriveWell employees also have access to a certified partner, FoodSmart, a digital nutrition platform with tools that make it easy to eat well! Within the platform employees can: 

  • See how their eating habits stack up and instantly get personalized tips and recipes. 
  • Find recipes based on dietary preferences or allergens/intolerances, time, and budget.  
  • Create a grocery list and more. 

Help get your team started with ThriveWell today by sharing this ready-to-send toolkit. 

High-Cost Claimant Team 

A small number of members—about 1%—often drive a large majority of a plan’s health care costs³. These members typically have chronic and/or complex conditions. Our High-Cost Claimant (HCC) Team provides these members with the full range of care and support they need to manage their conditions and comorbidities, maximizing positive outcomes. 

Care Management Team 

Through referrals, direct outreach, sophisticated data analytics, and coordination with providers, we tailor our approach to each member’s specific needs. We emphasize proactive and preventive care, encouraging members to stay ahead of issues, set goals, and manage their conditions and overall wellness, leading to higher overall member satisfaction. 

Excellus BCBS’ entire team of clinicians—nurses, doctors, pharmacists, dieticians, social workers, respiratory therapists, and customer care representatives work to ensure our members are in the center of care.  

Our registered dieticians are accountable for promoting better nutrition by speaking with members about diet and the relationship between eating habits and preventing/managing specific conditions and complications related to IBD care. 

In addition to our Care Management Team, members also have access to Therapeutic Resource Center (TRC) Pharmacists at Accredo who specialize in inflammatory conditions. 

HealthWise® Knowledgebase 

Employees have a wealth of health information at their fingertips through their member portal at ExcellusBCBS.com/login. By logging in, employees can explore the HealthWise Knowledgebase, which offers easy-to-understand information on thousands of medical conditions, symptoms, tests, and treatments. This comprehensive resource is designed to help employees make informed decisions about their health and wellness. 

To access this valuable tool, employees simply need to log in to the website. From the home screen, they can navigate to the Health and Wellness drop-down menu and select Research Health Topics. This will direct them to a vast repository of reliable health information, empowering them to take charge of their health with confidence. 

Wellframe® 

Free to all Excellus BlueCross BlueShield members, the Wellframe mobile app puts answers, tools, educational materials, and more at employees’ fingertips, so they have all the confidence to stay in control of their health. Within the platform they can: 

  • Text a Care Manager 
  • Get a personalized health plan 
  • Set up medication reminders 
  • Connect with a Dietitian 

When we say everybody benefits, we mean it. 

Our approach to benefits is born out of a larger focus on helping businesses care for their teams by bringing all aspects of care together for a more comprehensive, coordinated experience. It’s about putting people first, making service simple and leveraging the strength of an unmatched network to help make health care work better – for everyone. 

*Program eligibility may vary by funding arrangement. A shared savings fee or buy-up may also be associated with the program. Contact your account representative to learn more. 

1  Based on 2023-2024 Health Plan Claims Data 

2 2018-2023 data provided by Personify Health    

3 Cost savings based on 2023 claims experience for members engaged in CM   

4 2023 Health Plan Data   

Copyright © 2024, Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. All rights reserved. 

SaveOnSP is an independent company that offers specialty coinsurance assistance services for certain specialty prescription drugs to Excellus BlueCross BlueShield members. 

Excellus BlueCross BlueShield has contracted with Expion Health Company, an independent company, to provide HelpScript program benefits to our members. 

Personify Health is an independent company and offers a digital wellbeing service on behalf of Excellus BlueCross BlueShield 

Healthwise is an independent company that provides condition and disease management education to Excellus BlueCross BlueShield members.  

Wellframe is an independent company that provides a health and wellness support mobile app to Excellus BCBS members