Blue Cross Makes Prescription Drugs More Affordable for Members and Group Customers
Blue Daily
| 5 min read
Key Takeaways
- Blue Cross Blue Shield of Michigan capped the increase in prescription‑drug costs on its commercial plans at 2.6% for 2025, an 83% reduction from the prior year’s rise.
- Its biosimilar program saved $80 million in 2025 by switching high‑priced biologics such as Humira and Stelara to alternatives that cut list‑price costs by roughly 90%, with 99% of members staying on therapy.
- Site‑of‑care management, discount programs and specialty‑therapy initiatives — including caps on gene‑therapy fees and an oncology value pathway — produced more than $400 million in member savings across 2024 and 2025.
Skyrocketing prescription drug prices threaten the affordability of health care in Michigan and across the U.S. To help make medications more affordable for our members and group customers, Blue Cross Blue Shield of Michigan and Blue Care Network work to manage prescription drug costs and provide access to medicine members need through creative solutions. And we’re getting results.
In 2025, we held our total prescription drug cost increase across all our commercial health plans to 2.6% over 2024. That is 83% less than the rate of drug cost increases compared to the previous year.
How are we doing it? We’re negotiating prices, providing lower cost alternatives to expensive medications, matching members with discount programs, forging helpful partnerships and developing innovative programs.
Biosimilars
Our biosimilars strategy saved $80 million in 2025 and $67 million in 2024. We adopted biosimilars that saved our members and group customers 90% off the list price of top-selling expensive biologic drugs in 2025.
Humira® has been one of the most prescribed drugs in the country in recent years, at a list price of about $10,400 per month, according to the Red Book® for prescription drug pricing published by the U.S. Government Accountability Office in February 2025. We switched the preferred medication on most of our covered drug lists to a biosimilar called Simlandi® at a 90% savings in January 2025. We made a similar change for another expensive drug, Stelara®, in April 2025, moving to the biosimilar Yesintek® also at a 90% savings. In both cases, members are continuing their effective medication therapies, with 99% staying on the new biosimilar options, and saving money in the process.
We continued to move coverage from expensive brand-name biologic drugs to lower-cost biosimilars that are just as safe and effective throughout 2025. And we’ll continue to find and adopt those solutions in 2026 and beyond.
Drug discount programs
Blue Cross and BCN now offer five programs that provide members with discounts designed to help them to continue taking their medications as prescribed. In 2025, the five efforts combined saved almost $187.8 million.
These programs cut or eliminate member copays for certain drugs, ranging from high-cost infusions to routine generic drugs, with some programs offering bigger discounts every month that members refill their prescriptions on time. This helps members save on their out-of-pocket costs while improving what doctors call “medication adherence,” by helping members follow their prescribed treatment regimens and stay healthier in the long run. That can also help to avoid bigger costs in the future.
Site of care management
Members can receive injections and infusions of expensive specialty drugs at hospital outpatient departments, ambulatory infusion centers, doctors’ offices or at home from home infusion therapy providers. While the medications and quality of care may be the same in those different locations, the cost is not. The average cost for an infusion in a hospital outpatient department is $9,600, but the average cost in other settings is only $4,500.
We’ve moved coverage of certain infusions and injections from outpatient hospitals to other locations, saving members money and making their treatments more convenient. Our site of care management saved $131.5 million in 2024 by managing care for nearly 100 drugs.
Medical benefit drug management
While most prescription drugs are filled by a pharmacy and taken by a member at home, some drugs are given by a doctor or nurse as injections or infusions. Those drugs are covered under medical benefits the same way other medical procedures are. But Blue Cross and BCN closely monitor those along with other prescription drugs and manage coverage to give members access to safe, effective treatments at the lowest cost.
Our medical drug management programs saved $104.2 million in 2024.
Cellular and Gene Therapies Management Program
Some of the newest medication breakthroughs treat diseases on a cellular level, with some offering cures for serious conditions. But the price tag for these cellular and gene therapies can range from $100,000 to more than $4 million for a single dose.
Our Cellular and Gene Therapies Management Program provides access to life-changing care while protecting members and customers from unexpected high costs through price negotiations, caps on fees and drug manufacturer contracts that pay only for treatments that are successful.
Oncology Value Management Program
When you’re diagnosed with cancer, you count on your health care coverage to give you life-saving care. Our Oncology Value Management Program gives additional peace of mind by validating members receive the best treatments, according to nationally recognized guidelines, and aligning benefits for chemotherapy, immunotherapy and supportive care drugs. The program also identifies the best and lowest cost sites of care for treatment with those drugs.
Our Oncology Value Management Program saved $75.7 million in 2024 through these nationally recognized care pathways that improve quality.
Evio Pharmacy Solutions and CivicaScript
Blue Cross and Blue Care Network joined other Blue Cross and Blue Shield licensed health plans across the country to form partnerships that help lower prescription drug costs.
Evio Pharmacy Solutions is a partnership that improves affordability and access to medications through value-based care and innovative collaborations. Evio helped us to find the best solutions and negotiate the best prices for our biosimilar drug options in 2025.
We joined the Blue Cross and Blue Shield Association and 22 other Blue plans to launch CivicaScript in 2020 to develop lower cost generic drugs for distribution in the U.S. In 2025, CivicaScript released four generic drugs at prices significantly lower than averages at pharmacies nationwide. The savings range from $1,000 a month for a drug that treats prostate cancer to $4,300 a month for a drug that treats relapsing forms of multiple sclerosis.
Learn more about Blue Cross Blue Shield of Michigan's commitment to affordability here.
Image: Getty Images
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