Best Practices in CGM
Benefit Design: Payer
Experience Moving CGM Coverage from the Medical to the Pharmacy Benefit.
Joseph Albright, PharmD
Manager, Clinical Pharmacy Services, BlueCross BlueShield North Carolina
Joseph A. Albright PharmD, leads a team that provides clinical pharmacy services to over 1 million commercial members of Blue Cross and Blue Shield of North Carolina. These services include formulary and utilization management strategies to provide optimal clinical outcomes at an affordable price. Additionally, this team engages in the quality and cost management associated with their expanding accountable care organizations. During his tenure at Blue Cross, Dr. Albright has taken a particular focus on modernizing the clinical policies for prescription opioid use and for medication assisted therapy, promoting optimal diabetes management, and increasing medication adherence. Prior to Blue Cross NC, Dr. Albright managed teams in clinical operations for one of the largest Medicare Part D providers in the country. Before his career in managed care, Joseph practiced community pharmacy in Raleigh, North Carolina. He received both his Bachelor of Science in pharmaceutical sciences and Doctor of Pharmacy degrees from The Ohio State University.
Perspective on Real-Time CGM
“Increased presence in consensus guidelines for real-time CGM paired with hands-on experience ignited our investigation into expanding access. Our financial model showed that not only could we increase access but we could do it with similar healthcare dollars due to the favorable pricing on pharmacy. The move to covering CGM on pharmacy has been a win for the plan, for our members, and our providers alike.”