Pharmacy coverage
Blue Shield’s integrated approach to pharmacy and medical coverage gives you a smarter way to manage prescription drug costs. 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 should work hand in hand with medical coverage to deliver 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 together find the best treatment for each patient at the best price possible.
Our new Performance Formulary for self-funded benefit plans provides choice while maximizing savings.
Over 375,000 Blue Shield providers have access to real-time prescription cost information, accounting for greater than $81M in drug cost savings since the tool launched four years ago.
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 improves 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.
By integrating pharmacy and medical care, we save our clients $16-24 per member per month compared to carve-out models.
Our lower cost benefit design, formulary, and network options provide flexibility to best meet your needs.
We offer cost stability and quality assurance based on proven, data-driven strategies, so you can plan ahead.
One Blue Shield account team for both pharmacy and medical means streamlined administration for you.
A better member experience
When doctors and pharmacists work together, members benefit with a cohesive treatment plan and, with our customer care site, a single point of contact to get their questions answered.
We have a network of more than 64,000 pharmacies, including all key national and regional chains and independent pharmacies.
Blue Shield members have a seamless experience, with a single customer care team who answers 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.
Our Advance Practice Pharmacists help close gaps in care, improving medication adherence and ultimately health outcomes.
Members also have access to robust digital tools that make it easy to understand benefits, compare prescription costs, and track their pharmacy and medical spending.
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 steers members to more affordable medications, achieving an adoption rate of over 80% in favor of the biosimilar option.
We provide a drug-cost transparency tool to help doctors and patients decide in real time on the most appropriate, cost-effective medications, avoiding confusion or sticker shock later.
Our investment in CivicaRx – 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.
Our Advance Practice Pharmacists help close gaps in care, improving medication adherence and ultimately health outcomes.
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.
