Samir Mistry, named chief pharmacy officer at Blue Cross & Blue Shield of Rhode Island in December, has worked in managed care for two decades, focusing on strategies to improve and lower costs through provider partnerships and contracting.
Before working at the health insurer, Mistry was with pharmacy benefit manager Abarca Health, where he served as vice president, rebates and pricing strategies. While there, he led trade relations, analytics, outcomes and value-based contracting. Providence Business News asked him about his new job and home in Rhode Island.
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PBN: You recently moved here from Minneapolis. What are your impressions of the Ocean State?
MISTRY: Although it has been a significant change to move my family from Minneapolis to Rhode Island, I have found it to be a wonderful experience. It’s exciting to move to a small state that feels very family- and education-oriented. And we are constantly amazed at the beautiful water views, the beaches and shoreline, and of course, coming from the Midwest, the convenience of being able to be almost anywhere in the state in less than an hour! As a foodie, I am so impressed with the local culinary scene.
PBN: What does your job managing BCBSRI’s relationship with Prime Therapeutics involve?
MISTRY: The cost of prescription drugs continues to grow year over year, and will become a larger percentage of total health care expenditures if not effectively managed. Our work with Prime Therapeutics involves deep collaboration among our clinical, operational and leadership teams to develop and implement strategies to drive lowest net cost to our pharmacy benefits.
Prime plays a critical role in BCBSRI’s objective to make health care more affordable to Rhode Islanders. In the short time that I’ve been at BCBSRI, I have found Prime Therapeutics to offer an integrated approach to managing medications, which provides us the opportunity to effectively coordinate medication trend management across both pharmacy and medical benefits.
PBN: What are the biggest challenges in this position?
MISTRY: The most significant challenge for my role is to maintain a healthy balance in providing coverage for lifesaving medications to all of our membership in Rhode Island while managing the cost of those medications. It’s no secret that prescription drug costs have increased significantly over the last decade, and will likely continue to grow in the years ahead, especially when it comes to specialty medications. This makes it imperative for my team and me to develop a strategic vision and a multiyear strategy for sustainable prescription drug cost trends. It’s a delicate balance in trying to ensure our members have what they need while still keeping health care affordable.
PBN: How has the CVS Health Corp.-Aetna Inc. acquisition affected the market and your work?
MISTRY: The health care industry has experienced a great deal of consolidation and disruption over the last few years, and we’ve worked hard to understand and anticipate the potential impact and opportunities.
The CVS-Aetna acquisition coupled with the Cigna-Express Scripts merger are both examples of market segment leaders creating managed health care organizations that are set up to deliver an integrated system to manage both medical and pharmacy services.
This further confirms our approach with Prime Therapeutics to develop an integrated strategy to manage medication trends. The CVS-Aetna acquisition is one of just several consolidation moves that have happened in recent years, and these organizations seem focused on some of the same things we are – more-affordable health care, an improved patient experience and improved access to care.
I strongly believe that our success at Blue Cross & Blue Shield of Rhode Island will be driven by our unwavering commitment to being a deeply local company with Rhode Islanders’ well-being at the center of our mission.
PBN: What do you see for the balance of BCBSRI’s five-year relationship with Prime Therapeutics that started last year?
MISTRY: We will continue to work with Prime Therapeutics to develop our formularies and clinical programs with the goal of driving lowest net cost and sustainable pharmacy trends. Our ultimate goal is to be proactive and innovative, so we are prepared for new opportunities and creative solutions to manage pharmacy trends.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
