CALIFORNIA RHEUMATOLOGY ALLIANCE SOUNDS ALARM ON DANGEROUS POLICY CHANGE FROM ANTHEM BLUE CROSS Physicians & Patient Advocates Warn of Reduced Access to Care & Skyrocketing Drug Prices



The California Rheumatology Alliance (CRA), a specialty physician association comprised of rheumatologists from community practices and medical centers throughout California, released a letter it sent earlier this week to Beth Anderson, Anthem’s California Plan President. The letter requests a meeting and reconsideration of a proposed policy adjustment that will force patients to utilize Anthem’s preferred specialty pharmacies, making it nearly impossible for certain treatments (specifically infusion therapy) to be conducted in physician offices – under their care.



Many California physicians have received notices from Anthem stating the insurer’s policy will change on December 1, 2020, requiring the procurement of drugs from Anthem’s designated specialty pharmacy, regardless of less expensive options physicians can obtain via an open marketplace.



Normally, physician administered drugs are obtained via a “buy and bill” system where a physician purchases medication and bills the insurance company under a patient’s medical benefit. The new policy moves administered medications away from the physician and the patient’s medical benefit to the patient’s pharmacy benefit - effectively reversing work physicians have done to reduce patient costs for office administered medications.



The letter states in part:



“…As a result of Anthem’s policy change, patients will be increasingly forced into more expensive sites of care such as hospitals or to sites where there is no direct supervision by physicians, nurse practitioners, or physician assistants…



…Higher prices, and reduced access to care – surely these are outcomes you want to avoid…”



The full letter may be found here:

https://wp.calrheum.org/wp-content/uploads/2020-CRA-Letter-to-Anthem.pdf



“By disrupting the current model of care, Anthem Blue Cross is putting patients at risk,” stated Dr. Samy Metyas, CRA’s President. “Patients that delay treatment or go elsewhere (like a hospital) for care will experience longer waits, less oversight, and substantially higher out of pocket costs. Forcing patients to take on these added burdens, at a time like this, is shameful.”



By transferring medications covered on the medical side of insurance to the pharmacy side, insurers are expecting that more money can be made in the form of hidden fees and price concessions. However, costs rise at much faster rates under these scenarios than with physician procured medicines – a burden on the patient, on Anthem policyholders, and on employers that sponsor plans.



“In advance of the implementation of this policy, CRA and other patient advocacy organizations will be taking action to inform patients, employers, and regulators of the dangers accompanying Anthem’s new policy. Removing the acquisition of office administered medications away from the physician and to the patient’s pharmacy benefit through specialty pharmacy will be disruptive and costly for patients,” Dr. Metyas continued, “Anthem Blue Cross can still delay or cancel the implementation of this policy change and we hope they will see the light before it is too late.”



The California Rheumatology Alliance is a specialty physician association comprised of rheumatologists from community practices and medical centers throughout the state. The majority of its members come from the Northern California Rheumatology Society (NCRS), the Southern California Rheumatology Society (SCRS) and the San Diego Rheumatology Society (SDRS). Membership has since expanded to include all those health professionals regularly engaged in the care of patients with rheumatic diseases.



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Please visit https://www.calrheum.org/



For more information, or to schedule an interview with a CRA spokesperson, please contact Dan Rene at 202-329-8357 or daniel.rene@kglobal.com