Pharmacy coverage
Blue Shield’s integrated approach to pharmacy and medical coverage gives you a smarter way to manage prescription drug costs. You can explore tailored savings strategies and tap into our innovative cost management programs — all designed to provide a high-quality member experience.
Saving with integrated plans
Pharmacy coverage working hand-in-hand with medical coverage can offer better health
outcomes for members and greater efficiencies for employers.
Our effective cost management strategies are saving employers $16-24 per member per month compared to carving out pharmacy.
A better prescription drug cost management strategy
Our unified approach to utilization and cost management aligns medical and prescription benefits. Doctors and pharmacists collaborate to find the most appropriate treatment for each patient at an affordable price.
Our new Performance Drug Formulary for self-funded benefit plans provides choice while maximizing savings.
We provide doctors with a drug-cost transparency tool that allows real-time conversations with patients on the most appropriate, cost-effective medications, which has helped generate over $100 million in drug cost savings since 2022.
Our specialty drug program provides significant savings on high-cost drugs in both pharmacy and medical benefits via our networks, manufacturer contracting, and utilization management.
Blue Shield’s Prescription Savings Program supports medication adherence by offering members discounts on prescriptions if filled on time.
A holistic approach for large employers
Integrating pharmacy and medical coverage isn’t just about better outcomes and enhanced savings; it’s a simpler plan for employers to administer.
We’ll work with you to tailor coverage to your company’s population so you can get the most out of every healthcare dollar.
Our lower-cost benefit design, formulary, and network options provide flexibility to best meet your needs.
One Blue Shield account team for both pharmacy and medical means streamlined administration for you.
We provide consolidated medical and pharmacy cost/utilization reports as well as consultations to help you analyze and understand trends.
A better member experience
Our broad retail pharmacy network includes national chains plus independent pharmacies and grocery, discount, and drug store locations.
Members have a seamless experience, with a single Customer Service team able to answer both pharmacy and medical questions.
We provide coordinated case management for high-risk members (for instance, a cancer patient), helping them navigate treatment and services. When doctors and pharmacists work together, members benefit from a cohesive treatment plan.
Access to our Pharmacist Provider Network helps close gaps in care, which can improve medication adherence and ultimately health outcomes.
With robust digital tools, we make it easy for members to understand benefits, compare prescription costs, and track their pharmacy and medical spending. Our latest feature is a first-of-its-kind mobile app push notification that alerts members when their doctor initiates a new prescription, enabling them to view medication costs as well as any lower-cost alternatives.
An innovative mindset
We never stop reimagining a better health care system. As we bring more pharmacy solutions to market, you and your employees will benefit from safer, more equitable access to sustainably affordable prescriptions medications.
Our biosimilar program offers members more affordable medications, achieving an adoption rate of over 75% in favor of the biosimilar option and exceeding the national average.
Working with Fresenius Kabi and Evio Pharmacy Solutions, we were able to significantly cut the cost of treatment for members using the medication Humira by introducing an FDA-approved and clinically effective biosimilar for a transparent net price of $525 per monthly dose, compared to the market reported net price of Humira at $2,100.
Our collaboration with CivicaScript® – a nonprofit bringing affordable versions of generic medicines to market – has led to the launch of a prostate cancer drug that will cost no more than $171 a month, about $3,000 per month less than the average cost for someone with Medicare Part D.
Blue Shield also contracts with specialty and genetic therapy providers to reduce costs for employers and members alike.
Blue Shield’s digital tools make it easy to manage prescription costs
New and enhanced online tools are helping members explore their prescription options and access affordable drugs. From comparing prices to saving time and money with home delivery, members can see if they’re getting their medications for the best value.
