Get to know Blue

Q. Beyond your recent experiences building and revitalizing health plans, you’ve practiced as a clinician at a university medical center and served as a clinical instructor for three pharmacy colleges. Tell us more about how these experiences have shaped your perspective.

A. I worked retail pharmacy for two years. Then, I spent 10 years working in intensive care medicine doing daily patient rounds, research, teaching, and running a residency program. And from there I transitioned to the insurance side, helping to build, optimize or consolidate pharmacy operations for nine other health plans. It’s fair to say I’ve seen it from both sides.

I think back to my roots in rural Michigan, before Medicare Part D was available. I grew up in a town of about 2,500 people. They were mostly farmers or working in manufacturing. They would drop off prescriptions that cost $200 and then walk away because they couldn’t afford it. They were choosing between gas, groceries and prescriptions. I would think, “This patient just had a stroke. They need to be taking blood thinners.”

There just wasn’t as much financial assistance, health literacy was low, and you had to learn quickly how to work with folks to get them on a medication they could afford.

When I first got out of pharmacy school, 60% of the medications were brands: Prozac, Zoloft, Viagra. All of these are generic today and we also have two $4 million specialty drugs. But 85% of the drugs coming out on the market now through a retail pharmacy are generics at about $16.

So these things have shaped my perspective over time, especially as we’re building programs and formularies aimed at reducing total cost of care while keeping the member at the center of what we do.

Q. What do you see as the future state of the pharmacy industry? Looking at 2026 and beyond, how are we poised to meet evolving needs and what role will AI play?

A. Back to my previous point, look at retail pharmacies trying to make margin off $16 generics versus medications at $200 or $300. They’re filling 400 scripts a day. Which means there’s less time to work with a person, ask or answer questions for each person who’s coming up to your counter. There’s less time to do the clinical things that can make a difference in somebody’s healthcare.

We’re seeing retail pharmacies struggle and go under. The economics in that market are difficult.

As far as the future, the industry is pivoting from traditional blockbuster retail pharmacy brand pharmaceuticals to more precision medicine with specialty pharmacy and cell and gene therapies that are administered under the medical benefit.

AI will play a role in efficiency, better outcomes and better member experiences. Consider that right now at Blue Cross and Blue Shield of Minnesota, with our AI-powered tools, 60% of prior authorization approvals are completed within five minutes or less,¹ and we never use AI to deny care. Looking at it through that lens, efficiency leads to a better experience.

But we’re also making a concerted effort to look at prior authorizations to understand where they are necessary and to remove them when they don’t make sense. That’s also a smart path toward a better experience.

Q. Pharmacy costs are a major contributor to healthcare spending. How can employers, consumers, payers, pharmacy benefit managers and providers balance innovation, coverage and affordability to help members live their healthiest lives? How is Blue Cross addressing medication affordability?

A. Pharmacy has gone from an accessory benefit in the ’80s and ’90s to a significant cost driver, partly due to the increased pace of innovation in specialty drugs.

Take for example GLP-1s and expensive gene therapies, which are on everyone’s radar right now. Many are showing incredible promise to help people, which is great. Our challenge is to create a mechanism that makes it possible to access the medications in an affordable way for employers and members.

It’s our job to pull out all the stops to work on affordability for all stakeholders.

First and foremost, we work with our pharmacy benefit manager, Prime Therapeutics, to make sure we have the best discounts. We have an array of formularies, depending on what the given employer wants to offer, including generics or less expensive brands. This gives employers more options and control.

And the value of integration in driving medical savings is also huge for cost savings. Research shows when employers carve in pharmacy benefits with us, they achieve $422 per-member per-year savings through reduced hospital and ER visits and thanks to a variety of innovative programs and services.²

But some of those old levers we had when I first got out of pharmacy school might not necessarily be working anymore. That’s why we also work with providers to show the cost of non-preferred brands and where other equally effective, less costly options are available.

Providers aren’t obligated to make changes, but together we can help improve member health and have a big impact on costs just by having conversations, educating providers about the benefit and showing them the difference in price. I would rather work together with a provider and have a conversation about a non-preferred drug than do a prior authorization.

To be clear, it isn’t the fault of providers because they don’t necessarily know what’s covered and not covered. They’re working with so many patients. How would they know? Everyone’s benefits and formularies are different.  

Having those meaningful conversations gives us the opportunity to help keep costs down while providing great care. Once providers know the costs, they can change their prescribing practices for everybody because these strategies work for all payers. Plus, there is significant room to use AI and claims data to automate prior authorizations as well.

For us, it’s a case of working smarter, not harder.

Q. Please tell us a little more about you and your interests outside work.

A. Outside of the affordability chase I can be found doing early morning workouts, attending movies or live music, or traveling.

I’m a beach person and I’ve done a lot of the Caribbean, Aruba, Puerto Rico, St. Thomas, St. John’s a couple of times. Quick trips, get out and explore, check out the beach, check out the food scene.

I enjoy Canada, too, including Montreal, Toronto and Vancouver, but also camping a couple of times in Central Ontario.

Thank you, Jamie, and welcome to Blue Cross and Blue Shield of Minnesota.

Read more about the work Jamie leads to secure high-quality, affordable pharmacy benefits for employers and members:

• Unlock pharmacy savings with integrated programs
• Taming runaway specialty pharmacy costs