Blue Cross Works to Protect Members from Rising Drug Costs
Atheer Kaddis
| 3 min read
Atheer Kaddis is the vice president of Pharmacy serv...
Blue Cross Blue Shield of Michigan and Blue Care Network have been working to lower drug prices on many different fronts.
Here’s an update on a few recent efforts:
Partnership with Civica Rx
We joined with 17 other Blue plans to create Civica Rx in 2020 to address prescription drug affordability. Civica Rx will produce lower-cost versions of generic drugs for Blue Cross members and all Americans. The first medication available is abiraterone (Zytiga®), a treatment for prostate cancer. Civica Rx plans to release other generic medications in 2025.
High-Cost Drug Discount Optimization Program, powered by PillarRx
Specialty and other high-cost prescription drugs have made headlines for their rising costs nationwide. Our high-cost drug discount program helps members take advantage of manufacturer copayment assistance programs that significantly lower their out-of-pocket costs for more than 300 high-cost medications.
The program was expanded to include nearly 50 high-volume diabetes, cardiovascular and migraine drugs. This not only helps with affordability but also with adherence to drug therapies.
Drug Adherence Discount Program powered by Sempre Health
Every medication says it on the label: take as directed. Yet many people don’t. We’re working with Sempre Health to help members save money by reducing their out-of-pocket costs. Members get discounts when they refill their medications regularly as prescribed. With each refill, they may receive a bigger discount. This program has brought our members more than $10 million in savings since 2020.
Generics Advantage Program
We offer our free adherence pilot program – GAP. When BCN commercial members with pharmacy benefits fill prescriptions for select generic medications as prescribed, they save money on out-of-pocket costs. Members who adhere to their drug therapies are rewarded with discounts. With each refill they may receive a bigger discount. The program is focused on drug categories that are measured as part of HEDIS and STARS patient quality ratings with hopes to expand to Medicare.
Price Edge
We’ve saved Blue Cross members $32.3 million dollars and BCN members $22.9 million dollars on their prescriptions since June 2023 with our Price Edge program. Price Edge has directly saved our commercial members a combined total of $55.2 million dollars on their generic drug claims. This program automatically finds the lowest price available on select non-specialty, generic medications when members fill their prescriptions by scanning and comparing direct-to-consumer prices with insurance prices. The program works with both retail and mail-order pharmacies.
Evio Pharmacy Solutions
Blue Cross, in partnership with four other Blue plans, launched Evio Pharmacy Solutions to lower the rising cost of prescription and specialty drugs affecting our customer groups and members. Evio uses real-world evidence to support a value-based contracting model and is working with innovators in the value chain.
Blue Cross worked with its Evio partners to help launch Synergie Medication Collective, a group purchasing organization that’s focused on improving affordability and access to costly medical benefit drugs — ones that are injected or infused by a health care professional in a clinical setting. This effort is expected to benefit nearly 100 million Americans covered by Blue Cross Blue Shield plans across the United States.
Part of a larger effort
We’ll continue to keep our eye on ways to further reduce the cost of prescription drugs and enhance our pharmacy benefits. At Blue Cross, we believe medication should be both accessible and affordable.
Atheer Kaddis is the vice president of Pharmacy services at Blue Cross Blue Shield of Michigan.
Photo credit: Getty Images
Civica Rx is an independent company that will provide select generic drugs to Blue Cross Blue Shield of Michigan and Blue Care Network members.
PillarRx is an independent company providing Blue Cross Blue Shield of Michigan and Blue Care Network with a high-cost drug discount program.
Sempre Health is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to provide a drug discount program.
