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Lancaster County keeps Hinge Health MSK and biosimilar step-therapy programs for employee health plan
Summary
Board approved staying enrolled in the Blue Cross Blue Shield Hinge Health musculoskeletal virtual program and a CVS Caremark-administered biosimilar step-therapy for certain specialty drugs, citing projected cost savings and clinical safeguards including appeals for medical necessity.
HUB International consultant Sandy Ryan presented to the Board on Feb. 5 two proposed health-plan approaches for Lancaster County employees and recommended the county remain enrolled in both.
Ryan described the Blue Cross Blue Shield of Nebraska Hinge Health musculoskeletal (MSK) program as a virtual care option focused on pain management and physical therapy that is offered at no direct cost to employees and administered as a pass-through claim expense to the county health plan. The Board voted unanimously (4-0) to decline opt-out and remain enrolled.
Ryan also presented an Employers Health Stelara biosimilar strategy administered through CVS Caremark that would require participants using certain high-cost specialty medications to first try approved biosimilar alternatives, with an appeals process for medical necessity. The Board again voted 4-0 to remain enrolled.
Why it matters: The decisions affect employee access to virtual MSK care and specialty medication pathways and are intended to lower plan costs while preserving clinical safeguards. County staff said both programs include mechanisms to limit plan exposure and provide medical appeal options.
What's next: Human Resources will implement the programs and coordinate member communications and appeals processes with the plan administrator and HUB International.
