Recover password

Lower Costs Help Health Care Quality

As a community-owned health plan and as part of a larger not-for-profit health care system, Presbyterian Health Plan takes very seriously our obligation to provide access to high-quality health care and lower the cost of that care.

We know that affordability isn’t simply a financial issue, but that more affordable care improves care itself. For example, recently the Institute for Healthcare Informatics reported that patients over age 65 used 3.1 percent fewer medications in 2011 as a result of rising costs in a difficult economy.

A recent example of Presbyterian Health Plan’s efforts to lower medication costs is with our 33,000 Medicare Advantage members in New Mexico. While Medicare is reducing payments for health plans and providers to keep the program solvent for years to come, Presbyterian Health Plan is working hard to keep pace with these reductions.

This month, we started a new way to purchase specific classes of highly specialized medications for our Medicare Advantage members. We can obtain these medications for oncology and other specialties at much lower rates, and these are the same safe drugs that patients receive at Presbyterian hospitals.

This will lower out-of-pocket costs for our Medicare Advantage members by approximately $470 per year. We are required by law to pass those savings on to all of our Medicare Advantage members through lower premiums, enhanced benefits and improved services.

We know that this change is right for the plan’s Medicare Advantage members, and we are also aware that it means that some specialists in our community are no longer able to purchase and bill Presbyterian Health Plan for these same drugs.

Changes like this are difficult because they affect physician practices, but we feel strongly that our patients and members need us to lower the cost of their care while maintaining the same high quality and safety of their medications.


Continue reading

As physicians, we understand how important continuous patient care is during changes like this. Presbyterian Health Plan was very thoughtful about ensuring a seamless transition for our members, and with this change, members who currently receive these specialty medications at their physician’s offices will continue to do so as the medication will be safely delivered by the Presbyterian Specialty Pharmacy directly to physicians’ offices.

The only difference to the patients should be that the medications will cost them less.

Many independent oncology providers in the community are choosing to continue to deliver these medications in their practices. We have been reaching out to all physician practices affected by this change and will continue to put our Presbyterian members and their care at the forefront of these discussions.

We stand by our efforts to reduce the cost of care for our members, while at the same time ensuring that their care is seamless. This is a positive change for our patients and members and shows how health care can become more affordable.

At Presbyterian, we remain committed to fulfilling our purpose of improving the health of the patients, members and communities we proudly serve.