Blue Cross and Blue Shield Plans Offer Wider Access to Out-of Network Services, New AIS Database Finds

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BCBS plans are 7.5% more likely to offer out-of-network benefits than non-BCBS plans, according to analysis from Atlantic Information Services’s new online subscription database of prescription benefit design parameters.

Blue Cross and Blue Shield (BCBS) plans are more likely to have lower out-of-network costs and access to more out-of-network services compared with non-BCBS plans, according research conducted by the editors of Atlantic Information Services, Inc.’s (AIS) Rx Benefit Design Data (RxB), a new online subscription database with detailed data, news and insight on prescription drug benefit parameters of health plans. RxB allows subscribers to analyze out-of-pocket costs related to pharmacy benefits for all individual and small-group commercial plans on the market.

According to analysis from RxB of 6,954 individual and small group commercial products competing in the same states and metal levels in 2015, BCBS plans are 7.5% more likely to offer out-of-network benefits than non-BCBS plans. They also feature lower member deductibles, lower drug deductibles and lower maximum out-of-pocket limits for out-of-network benefits. This is likely due to efficiencies achieved by the Blue Cross and Blue Shield Association's nationwide BlueCard program, a national program that enables Blues plans to serve one another’s members that reside outside of the contracted plan’s licensed service area, RxB researchers say in a special report. However, BCBS product offerings feature a higher annual deductible, on average, for in-network benefits and slightly higher annual out-of-pocket limits.

To read the RxB special report, visit http://aishealthdata.com/system/files/download/BCBSvsNon-BCBSOOPcosts2015.pdf, which includes a breakdown of out-of-pocket costs by metal tier, by state.

RxB was developed by researchers in AIS’s Directory and Databases Division, the company’s exclusive in-house research team that also creates the industry-leading AIS’s Directory of Health Plans. AIS designed the user-friendly RxB database to quickly retrieve the details of prescription drug benefit offerings of each insurer on and off public insurance exchanges, with options to sort by plan name, plan type and metal tier, for both individual and small-group commercial plans. The data include out-of-network amounts and limits where applicable. The RxB database contains cost-sharing information on 7,643 plans for the 2015 plan year, as well as 7,309 plans for the 2014 plan year — a robust data set that allows for accurate trend analysis on many plan benefit design features.

For more information and to use a fully interactive demo of RxB, visit http://www.AISHealthData.com/RxB.

About Atlantic Information Services
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.

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Susan Namovicz-Peat, Director, Directories and Databases Division
Atlantic Information Services
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