Blue Cross NC Introduces New Autoimmune Pathways Program

Medications used for rheumatic diseases are now the number 1 contributor to the specialty drug spend. Six of the top 10 specialty drugs with the most spend are for rheumatic diseases.

For this reason, starting July 1, 2023, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement the Autoimmune Pathways Program through program vendor Outcomes Matter Innovations (OMI) with the goal of preserving outcomes and reducing costs for members with chronic inflammatory disease.

Blue Cross NC in-network rheumatologist providers will now have the opportunity to utilize a web-based machine-learning technology platform operated by OMI that suggests evidence-based care pathways.

This shared savings program will address provider use of these high-cost specialty drugs for patients with rheumatoid arthritis or psoriatic arthritis and will allow high-cost specialty drugs to be utilized efficaciously for better outcomes as well as reduced medical expenses.

The program will seek to support members remaining on their non-biologic medication as long as clinically appropriate prior to switching to a more expensive biologic medication. For members who are taking a biologic medication, the evidence-based care pathways encourage dose tapering or a medication holiday if the member is in remission or showing low disease activity.

OMI may reach out to you to facilitate contracting, onboarding and training prior to and ready for the July 1, 2023, go-live date.

For any questions, please reach out to OMI at support@omimanagement.com or call the Rheumatology Division Dedicated Support Line at 201-839-2266.