Pharmacy Integration

Contributing expert: Elvin Montanez, PharmD

Pharmacy benefits can have a dramatic effect on our consumers' health — and on care providers' ability to effectively manage their patients' health. That's why our pharmacy benefits manager CarelonRx is reimagining its offerings to make them more affordable, efficient, and effective for our care provider partners and the patients they serve.

While those efforts apply to our entire continuum of pharmacy services, the strides we're making on the specialty front — an area that represents a large, growing portion of overall healthcare spend — have the potential for the greatest impact.

Rising Specialty Drug Costs

Nationally¹

Specialty spending:

Increase of

43%

in 2023 from 2016

Specialty prescriptions:

Increase of

0.5%

in 2023 from 2016

CarelonRx²

Specialty spending:

~ 40%

of total pharmacy spending in 2021

Specialty prescriptions:

< 1%

of total pharmacy prescription volume

Enhancing Our Specialty Solutions

In 2023, we acquired BioPlus Specialty Pharmacy to address specialty cost issues, scale our offerings, and improve the consumer and care provider experience. Before joining CarelonRx, BioPlus was the largest independent specialty pharmacy provider in the country.³ It's licensed in all 50 states and has access to more than 150 limited distribution drugs, representing approximately 90% of CarelonRx's specialty prescription volume.⁴ Forbes Health has recognized BioPlus as one of the nation's best online pharmacies.⁵

BioPlus is already promoting affordability for our consumers, reducing administrative burden for our care provider partners, and improving collaboration among all stakeholders.

Rethinking Specialty Pharmacy

Learn how BioPlus is making an impact for care providers and their patients from Chief Operations Officer Elvin Montanez, PharmD.

When I was practicing, I remember one of my colleagues, a physician, was telling me as I was rounding with him — he said, "You know, if I could diagnose and focus on the decision to treat a patient, write the prescription, and then you take it from there, the practice of medicine would become a lot more effective for all of us, and the patients would experience that treatment."

And that's exactly what model the BioPlus organization has focused on.

We realize that it's not the medication, so much as it is the partnership that we provide. The doctor can focus on diagnosis and treatment. We focus on the prescription, and that prescription journey with the patient. We'll communicate, and that's really the genesis of the two-hour guarantee. As soon as they send us that prescription, we let them know within two hours what to expect, what we have, and what we need.

Total health is what Elevance Health is all about, and BioPlus is really focusing on that as well. As part of a vertically integrated system, we want to be able to screen our patients. We are treating a condition, but we also know that the whole person has to be accounted for; because if they need help, we want to be able to offer them that help.

And that's, I think, a big advantage that BioPlus now has and is able to offer. It's patient-based at large.

Reducing Burden for Care Providers

What sets BioPlus apart is its "fast and easy" approach to onboarding. It boasts a time-to-start-therapy guarantee that's 3 to 4 times faster than the competition and offers oncology patients "hope in 24 hours," guaranteeing all new oncology patients' prescriptions ship within 24 hours of a prescription being written by a care provider.⁶

Scaling Our Specialty Impact

BioPlus drives affordability for prescriptions, improving access to critical medications and enhancing the patient experience. We're expanding BioPlus' service models across more complex disease treatment areas to provide timely access to medications, deliver leading support services for care providers and patients, and ensure individuals receive distinctive clinical expertise and service.

New BioPlus Specialty Sites

New locations dedicated to serving care providers and consumers include Las Vegas, Nevada; Denver, Colorado; St. Louis, Missouri; and Indianapolis, Indiana. New capacity-driven automation dispensing sites include Pheonix, Arizona; Indianapolis, Indiana; and Raleigh-Durham, North Carolina.

1 Sonal Parasrampuria, Stephen Murphy: Trends in Prescription Drug Spending, 2016-2021. HHS Office of Science & Data Policy. (September 2022): aspe.hhs.gov/reports/trends-prescription-drug-spending. 2 CarelonRx, Investor Day presentation (March 2023). 3 Elevance Health press release: Elevance Health Announces Closing of BioPlus Acquisition (February 15, 2023): elevancehealth.com. 4 CarelonRx, internal data (November 2023). 5 BioPlus press release: BioPlus Earns a Spot on Forbes Health's 'Best Online Pharmacies' List (January 2023): bioplusrx.com. 6 BioPlus, internal data (2022).

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