Blue Cross Programs Save Members Millions on Prescriptions

by Blues Perspectives

| 3 min read

Pharmacist wearing protective hygienic mask and making drug recommendations in modern pharmacy
Taking your medications as prescribed is important for your health and could prevent a trip to the hospital. But some prescription medications can carry high costs, forcing some to make impossible choices between their health and their bills. Blue Cross Blue Shield of Michigan and Blue Care Network work with independent companies to address the high out-of-pocket cost of certain drugs, which can make it hard for some members to take their medicine as their doctors prescribed. We take a close look at drugs available under both the specialty and retail pharmacy benefits, along with certain maintenance medications for diabetes, cardiovascular and respiratory drugs. Here are two programs you may not be aware of that save members money.

The High-Cost Drug Discount Optimization Program, powered by PillarRx

This program helps commercial members get copay assistance from drug manufacturers for specialty and high-cost drugs at retail and specialty pharmacies. It started in July 2020, as an option for our self-funded groups, and is generating an average of 25% savings on the cost of select drugs. In January 2021, the program was also incorporated into our fully insured pharmacy plans. Members will save money on approximately 300 specialty and high-cost drugs.
How it works
Blue Cross and BCN members are eligible for savings based on their previous claims for drugs included in the program. PillarRx sends introductory information to eligible members and then calls to enroll them and explain how the program works, what to expect at the pharmacy and answer questions. PillarRx communicates with pharmacies to send members’ discount information. After members are enrolled, there are no other steps they need to take to save on their specialty and other high-cost medications in the program.

The Drug Adherence Discount Program, powered by Sempre Health

This program focuses on certain drugs used to treat common chronic conditions where following doctors’ orders can improve health and prevent serious complications. This coupon program is expected to expand over time and currently includes select medications used to treat:
  • Diabetes
  • Cardiovascular conditions
  • Respiratory conditions
The program saves our members money while also helping them follow their doctors' orders by refilling prescriptions on time. The program has already saved $3.2 million. The program’s now a standard benefit for all members with commercial Blue Cross pharmacy coverage.
How it works
Blue Cross identifies eligible members who have filled a prescription for a qualifying medication. Then Blue Cross and Sempre Health send members information about the program and enrollment through letters, postcards and emails. Once enrolled, Sempre Health will send text message or email reminders, based on member preferences, when it’s time for the member to fill his or her prescription every month. When the member refills and picks up the prescription on time, he or she will earn a discount on the copay. The member simply gives the pharmacist a discount code from the text messages or emails. Monthly discounts increase as the member refills prescriptions on time.
Blue Cross started the Drug Adherence Discount Program in late January 2020. By September 2021:
  • 89% of members refilled prescriptions on time
  • $3.2 million saved by members
  • $46 average discount per refill
  • $27 average copay
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Photo credit: Getty Images

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MI Blues Perspectives is sponsored by Blue Cross Blue Shield of Michigan, a nonprofit, independent licensee of the Blue Cross Blue Shield Association