Utah's employee health plan paid workers $500 to fly to Mexico for cheaper specialty drugs

Vox reported in February 2020 that the insurance plan for Utah government employees decided two years earlier to curb drug costs by paying workers to travel to Canada or Mexico for the same medications. Patients taking one or more of 13 specialty drugs can go to Vancouver or Tijuana, pay only their usual copayments, and have airfare, transport and lodging paid, plus $500 cash. The plan works with a Mexico-based pharmacy, Provide Rx, which arranges purchases and travel, with patients met at San Diego airport and driven across the border.

Uptake was low. The plan had already covered travel for procedures at the same Tijuana hospital with no takers; the $500 seemed to make the difference. Only 10 patients had gone, saving $225,000, not the $1 million hoped for, per the Salt Lake Tribune as cited by Vox. Even so, the saving covers airfare plus the bonus and could be used to lower premiums.

A health policy researcher said it was the only case she knew of where such cross-border buying was a sanctioned part of the US insurance system.

Pay the patient's trip and a $500 cash bonus to buy the same drug abroad, because the price gap is bigger than the cost of the flight.

US drug prices are much higher than those in Mexico and Canada, so there is room to pay for travel and still save.

Patients pay only their usual copay, so there is no cost to them.

A $500 cash bonus gave patients a reason to go through the effort, as free travel alone had not.

A pharmacy partner handles purchases, travel and escorts, reducing hassle.

A cash incentive can unlock a saving that a free benefit could not; the previous travel-cost offer attracted no takers.

Vox calls it not a sustainable model for curbing costs and flags concerns about making sure medications bought in Mexico are safe, and about travel risk for patients on drugs such as Enbrel that raise infection risk. The $225,000 and 10-patient figures come from the Salt Lake Tribune report as relayed by Vox.