Blue Cross Works to Protect Members from Rising Drug Costs

Atheer Kaddis

| 3 min read

Atheer Kaddis is the vice president of Pharmacy services at...

Blue Cross Blue Shield of Michigan and Blue Care Network have been working to lower drug costs on many different fronts.
We announced recently that our partner, Civica Rx, plans to produce three insulin medications and make them available to consumers next year at a significant discount.
This marked the latest salvo in the war to combat rising drug costs.
Here’s an update on a few recent efforts:

High-Cost Drug Discount Optimization Program, powered by PillarRx

Specialty and other high-cost prescription drugs have made headlines in recent years 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. 
In April, 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. To date this program has brought our members over $7 million in savings.

Generics Advantage Program

In March we launched our newest 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 pilot is focused on drug categories that are measured as part of HEIDS and STARS ratings with hopes to expand to Medicare.

Price Edge

This year, we’ve saved Blue Care Network members $1 million on their prescriptions in the first four months of a new program called Price Edge. 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 

In June 2021, Blue Cross partnered with four other Blue plans to launch 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 recently 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.
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.
MI Blues Perspectives is sponsored by Blue Cross Blue Shield of Michigan, a nonprofit, independent licensee of the Blue Cross Blue Shield Association