In January 2021, more than 800 drugs increased in price by an average of 4.6%, according to a recent analysis. Drug manufacturers can increase the price of medication at any time without notice or oversight, but typically do so either at the beginning or the middle of the year. It’s one of the reasons prescription drug prices are unpredictable and the cost of medication can be harmful to patients’ health – especially if they buy a drug without insurance or use a plan with a high deductible. Three in 10 adults reported that within the past year they didn’t take their medication as prescribed because of the cost, according to the Kaiser Family Foundation. Not taking medication as prescribed harms patients and can lead to serious health problems. Drug adherence failures account for 10% of hospital admissions and 22% of nursing home admissions every year. Blue Cross Blue Shield of Michigan and Blue Care Network use multiple strategies to keep premiums and cost trends affordable for clients and members despite these price hikes. Some of these include the Drug Adherence Discount Program, powered by Sempre Health, and the High-Cost Drug Discount Optimization Program, powered by Pillar Rx. Our pharmacists diligently work behind the scenes, using analytics, reports, clinical reviews and more to ensure members have access to safe, high-quality prescription medications. We have processes in place to evaluate our drug offerings and ensure we continue to provide our members access to the most cost-effective drug therapy. Throughout the year, a group of doctors, pharmacists and other experts research drugs to find alternatives or change how we cover them to keep your overall plan affordable. Part of Blue Cross’ strategy is to use drug lists, also known as formularies, with the goal of helping members get the best treatment outcome with the most cost-effective drug. These drug lists are used during step therapy, a program that guides your prescription drug coverage. The program starts by covering less expensive drugs that have been proven effective for patients with similar conditions before you take a “step” to a different medication. If a doctor prescribes you a medication for an expensive or high-cost new drug, or for a drug with safety concerns, Blue Cross may examine your medical and pharmacy history to ensure you’ve tried existing, safe drugs first. Additionally, Blue Cross gives members and health care providers access to information on drug pricing so they can find access to potential alternative medications, if applicable, that would be just as effective but available at a substantially lower cost. For members, drug pricing information is available through their Blue Cross online account. Providers can access this information through real-time prescription benefit checks within their electronic medical record system. This resource allows health care providers to discuss drug options with their patients in real time to weigh the best options. More from MIBluesPerspectives:
- Why Does the Price of Medication Change?
- Everything You Need to Know About Drugs Covered by Insurance
- How Prior Authorization Affects Your Prescription Drugs
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