Elevance Health buys specialty pharmacy BioPlus from CarepathRx

Steven Loeb · November 9, 2022 · Short URL: https://vator.tv/n/556c

BioPlus lets patients get quick access to their specialty meds, and helps with financial assistance

If a patient is prescribed a specialty medication for a complex or chronic disease, such as cancer, multiple sclerosis, hepatitis C, or rheumatology, they can't just go and pick it up at their local pharmacy. That's because, unlike a regular prescription for common problems, a specialty medication might be more complicated; patients might need to inject it or keep it at a certain temperature in the fridge. It also requires paperwork to be approved by health insurance.

They are also expensive: while though less than 2% of the population uses specialty drugs, those prescriptions make up over 50% of total pharmacy spending, and they are more expensive, costing health plans sponsors $38,000 on average to cover, while non-specialty drugs cost $492.

That's where specialty pharmacists like BioPlus come in. The company wants to expand access to these medications, lowering the cost while also making it faster and easier for patients to receive get their prescriptions. 

Now the company will be able to reach a wider swath of the population as it has been acquired by Elevance Health (formerly Anthem) from CarepathRx. No financial terms, which was announced on Wednesday, were disclosed but it was revealed that after the acquisition closes, which Elevance expects to happen in the first half of next year, BioPlus will operate as part of IngenioRx, Elevance Health’s pharmacy benefit manager within Carelon, its healthcare services brand.

Once the deal is finalized, Carelon will connect its businesses through BioPlus' digital platform, so that when a BioPlus’ pharmacy team identifies a patient who may need behavioral health support or in-home care services, the team will be able to connect that patient to Carelon's services.

When BioPlus receives a referral, its admissions team immediately contacts the patient’s insurance company about their plan’s pharmacy benefits. It is then able to tell the doctor’s office within two hours it it can fill prescription; if the prescription needs a prior approval, BioPlus will work with the doctor to get and submit any needed paperwork. It also allows patients to refill qualifying prescriptions.

In addition, BioPlus also connects eligible patients with financial assistance resources from non-profit foundations. 

Elevance Health says the acquisition will help it meet the specialty drug needs of its clients and customers. That means expanding BioPlus' model across more complex disease treatment areas. BioPlus currently offers Centers of Excellence (CoEs), which address therapeutic areas such as oncology and multiple sclerosis; CoEs include teams of specialized pharmacists and clinicians knowledgeable in therapeutics areas who partner with patients, and Elevance Health will look to build out additional CoEs for those additional therapeutic areas. 

“As a trusted, lifetime health partner, the acquisition of BioPlus helps us deliver on our whole-health strategy that gives our consumers improved access and reliability to their prescriptions when they need it most,” Pete Haytaian, Executive Vice President of Elevance Health and President of Carelon, said in a statement.

“In making BioPlus part of the Elevance Health family, we are committed to leveraging our resources to scale and broaden the reach of BioPlus’ best-in-class specialty pharmacy capabilities, delivering greater affordability and access to critical medications.”

(Image source: bioplusrx.com)

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