Free Market Health (FMH) is a healthcare technology company that orchestrates and optimizes the specialty drug fulfillment process. In [Month, Year], Blue Cross NC is partnering with FMH to launch an innovative specialty pharmacy program for our ACA and Commercial members. The new program enables a dynamic referral process that facilitates a match between specialty pharmacies and authorized referrals based on quality and cost.
Why are we partnering with Free Market Health?
- To increase process efficiency, improve care quality, and decrease the time it takes for members to receive their medications.
- To offer transparent and fair access to authorized referrals to our specialty pharmacy network and reward high-quality care.
- To leverage dynamic market rates at the referral level to ensure specialty drugs remain affordable for our members.
How does the program work?
- Upon an approved prior authorization for select specialty drugs, FMH receives the referral for management.
- FMH orchestrates Blue Cross NC's program configuration and evaluates the referral based on drug, disease, member and plan attributes.
- The referral, inclusive of care accountabilities and incentives, is matched to an in-network specialty pharmacy best-suited to service the referral.
- The assigned specialty pharmacy will reach out to the prescriber to obtain the prescription and onboard the member to initiate service.
What drugs are included in the program?
View the list of specialty drugs managed by the FMH program here.
How does this impact the specialty pharmacy network?
Specialty pharmacies participating in the FMH program gain:
- Expanded access to authorized specialty drug referrals
- Control over the types of referrals they pursue
- Time and money back previously spent on misdirected referrals
- Additional reimbursement for high quality care
To participate in the FMH program and continue servicing Blue Cross NC ACA and Commercial members after [LAUNCH DATE], network pharmacies must sign an addendum/contract with Free Market Health.
How does this impact prescribers?
The specialty pharmacy matched to the referral will reach out to the prescriber office to obtain the prescription, and prescribers may notice new specialty pharmacies servicing their patients. The assigned pharmacy has Blue Cross NC’s authorization to service the referral.
How does this impact members?
The specialty drug referral process under FMH is managed and streamlined to decrease the time it takes for members to receive their medications, monitor first fills, and reduce medication abandonment for members in need of and authorized for a specialty drug. Members are also serviced by a specialty pharmacy capable and accountable to meet their needs with focused care management that improves the patient experience.
Specialty pharmacies wanting more information on the Free Market Health program or in need of program assistance can contact the FMH team at 877-787-0520 or via email at email@example.com.
For all other inquiries, including member support questions, please contact Blue Cross NC at [PHONE] or [EMAIL].