Responding to Continued Misleading Claims by the Coalition of State Rheumatology Organizations

In a pair of recent press releases, the Coalition of State Rheumatology Organizations (CSRO) continued to incite fear in patients as it attempts to fight our specialty pharmacy changes.

Our program, which went into effect Jan. 1, 2020, requires providers to obtain specialty drugs from one of our in-network specialty pharmacies. We have not changed the list of provider-administered specialty drugs we cover. We are still paying providers for their services to administer these drugs. And we have not asked our members to change where they seek care.

The program only applies for around 100 self-funded employer groups who directly fund their members’ care while using BlueCross networks and our clinical quality and care support services. We estimate our program will save them 20% on this expensive class of medications. The savings go directly to those employers and the members they cover, not to BlueCross or a pharmacy benefits manager (PBM). 

Increasingly, our customers have been asking us for help with the rising costs of these drugs, and we’ve asked providers to work with us. We implemented this program to save them money with limited changes for their members’ care experience.

To help providers adjust, and to give us time to respond to the constructive feedback offered by some providers, we added a six-month transition period. During that time, we also added two new options that allow providers to continue using their preferred processes:

  • Joining our specialty pharmacy network
  • Signing a “dispensing provider agreement,” which lets providers continue to buy and bill, but at the same rates as our in-network specialty pharmacies

Numerous in-network providers have taken advantage of those options.

Unfortunately, some providers, and organizations like CSRO, have not taken the time to fully understand how our program works or even acknowledge the new options we’ve made available. CSRO in particular continues to make misleading claims and prey on consumers’ fears — even blatantly using the COVID-19 pandemic — as they attack our changes. But at a time when many business are feeling the effects of an economic slowdown, we believe these savings are more important than ever.

We’ve shared information to set the record straight on these misleading claims, and CSRO’s aggressive tactics leave us to believe they are prioritizing profits over patients.

As we’ve said, we’re still paying providers to administer these drugs, we’re still covering the same list of drugs, and we are not asking members to change where they get care. So claims by CSRO and others that we are “forcing” providers to refer their patients elsewhere are misleading and false. Any provider who refuses to treat a BlueCross member in this program is making their own choice to do so. They’re also making life harder for their patients instead of helping make their care more affordable.

Fortunately, many providers within Tennessee are following our new process, or have chosen to join our specialty pharmacy network or sign a dispensing provider agreement. We appreciate their collaborative efforts to help deliver cost savings to Tennessee businesses and their employees.

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