Blue Cross Pharmacy: Striving to Drive Down Drug Cost


| 3 min read

It’s no secret that drug costs have steadily increased over the years, leading to more frequent bouts of “sticker shock” at the pharmacy. That’s why it’s more important than ever to understand the complex nature of drug costs. The good news? Our pharmacy team has developed several programs to combat increases and empower members to help drive down drug costs. Keep reading to learn how these programs work and how you can be a more responsible consumer. Prior Authorization Prior authorization is one measure the Blue Cross Blue Shield of Michigan pharmacy team uses to drive down drug costs. This checkpoint in the prescription process allows our team of clinicians to evaluate prescriptions and ensure that you’re getting the best value and best results. While it may seem restrictive initially, this program benefits members in the long run. It prevents wasteful spending when there is a less expensive yet effective and safe option, helping regulate costs overall. You can learn more about prior authorization and how it impacts your coverage here. Quantity Limitations Quantity limitations in Blue Cross’ pharmacy program enhance patient safety, reduce waste and prevent abuse. When drugs are over-prescribed, medicine is wasted and prices increase for everyone. These limitations work by ensuring clinically appropriate dosages are prescribed to make sure drugs are taken correctly and only as-needed. What Members Can Do Believe it or not, there are several things you can do as a consumer to help drive down drug costs. Do your homework and be your own advocate by speaking candidly about your prescription needs and expectations with your doctors. Let them know that you’d like the most effective drug you can get for the lowest copay, for instance. Ask your doctor if a generic drug is available to treat your condition. Generics provide the same results and reduce costs for both you and your benefits provider (often your employer). Be a critical consumer. Keep in mind that as new drugs are launched, they often come with flashy ad campaigns and coupons that reduce prices temporarily but drive costs up in the long run. This happens because coupons help reduce your copay on brand-name drugs, encouraging you to pursue that pricier option instead of a less expensive one. However, your benefits provider does not see a discount. Your employer or other benefits provider still pay the more expensive price for the brand-name drug. By choosing to take a discount on the more expensive drugs, consumers are inadvertently contributing to rising health care costs, which often translates into higher insurance premiums. Conducting research and inquiring about inexpensive but equally safe, effective alternatives can help avoid excess spending on prescription drugs. For more information about pharmacy coverage and drug costs check out these blogs:
Photo Credit: Bill Brooks
MI Blues Perspectives is sponsored by Blue Cross Blue Shield of Michigan, a nonprofit, independent licensee of the Blue Cross Blue Shield Association