Pharmacy costs are a major driver for healthcare expenses today, climbing from $141 billion in 2001 to $378 billion in 2021. That cost is projected to grow by 57% to $592 billion by 2031.1 For employers, choosing the right partner for pharmacy benefits is more important than ever. Benefits leaders face considerations such as high-cost brand-name medications, specialty pharmacy options for complex conditions, and an aging population with higher incidence of chronic disease.
At Blue Cross, we partner with Prime Therapeutics (Prime) to offer innovative pharmacy benefit solutions that help employees access the medications and therapies they need while maintaining cost-effectiveness. When carved in, this program results in $422 per member per year savings, nearly three times the savings of a national competitor's carve-in plan,2,3 and provides a better member experience. While there are other ways for insurers to generate healthcare savings, our focus on trust means member need and safety are at the forefront of our services versus over-reliance on back-end tactics that can result in member frustration.
Innovative programs with proven savings
Prime and Blue Cross implement and regularly evaluate new program options and benefit design to ensure savings are built in – from clinical solutions to faster approvals.
Formulary and medication management
Our formulary and medication management programs offer savings for both members and their employers by eliminating medically unnecessary options, replacing brand-name medications with safe and effective alternatives, and making it easier for prescriptions to be picked up or delivered from a pharmacy.
KeyRx
$6.00 PMPM4 employer savings
Our lowest net cost approach to a managed formulary, guiding members toward safe and effective medications and replacing high-cost brand names with affordable alternatives and reducing medically unnecessary prescriptions.
IntegratedRx® — oncology
$6,640 employer savings per utilizing member5
Streamlined treatment pathway for people living with cancer, allowing them to receive their cancer-related prescriptions at local participating pharmacies that are part of their oncologists’ clinics, hospitals or healthcare systems.
Split fill — oral oncology
$581 employer savings per month6
Partial fills of oral oncology prescriptions with prorated cost share to confirm effectiveness and tolerance before committing to a full supply.
Network and discounts
Blue Cross has deep expertise in network management, strategically contracting with pharmacies to design networks that enable access and affordability. Additionally, we’re always looking for ways to provide a seamless employee experience by making it easy for members to take advantage of coupons and discounts.
Pharmacy network options
$4.25 PCPM7 employer savings with Classic Network
Flexible networks, based on employer preferences, balance access and cost. Our Classic Network, includes more than 50,000 pharmacies.
FlexAccess
$8.04 PMPM6 employer savings
Copay assistance to help members and employers save money on select high-cost specialty medications while optimizing manufacturer assistance dollars.
MedsYourWay®
$14.44 member savings per prescription7
Program to help employees find the lowest price for their prescription through the integration of drug discount card pricing, regardless of whether their prescriptions are filled via home delivery or at a retail pharmacy. Free, fast delivery of medication to their home with integrated discount card pricing that reduces costs.
Innovative technologies
Blue Cross and Prime stay at the forefront of pharmacy benefit innovation by exploring new technology and approaches that improve employee experience and focus on affordability.
GuidedHealth
$0.73 PMPM8 employer savings
Analysis of medical and pharmacy claims data for 360-degree member profiling that delivers actionable, personalized clinical intelligence to providers and plans, addressing gaps in care and potential misuse.
Pharmacy Utilization Management
$2.25 PMPM8 employer savings
Part of our Cost Protection program to ensure safe and appropriate drug utilization, dose and stepped approach to care through prior authorization, quantity limits and step therapy.
Medical Pharmacy Solutions (MPS)
Implemented in August 2024, savings information forthcoming
Prime Therapeutics Management MPS helps control medical specialty medication costs through prior authorization and utilization management support with this industry-leading program that combats drug waste and optimizes dosages. Artificial intelligence preauthorization solutions get to a faster "yes,” with approximately 60% of requests approved within five minutes.
Focus on high-cost therapies
In addition to programs that address overall affordability, Blue Cross and Prime work together to develop flexible solutions based on specific therapies that are contributing to increasing healthcare costs, such as GLP-1s and cell and gene therapies.
Synergie Medication Collective
Going live later this year
The Synergie Medication CollectiveSM is a leading comprehensive national solution to improve access and affordability for the highest-cost treatments of rare disease.
Synergie’s portfolio of products manage costs while ensuring quality care and a positive patient experience. With a core philosophy rooted in partnership and transparency, Synergie aims to play a key role in ensuring affordable access to treatment.
GLP-1 intervention: KeepWell
$150 – 600 PMPM9,10 employer savings
KeepWell offers a personalized and effective path to wellness, driving better outcomes across the cardiometabolic spectrum, including diabetes reversal, managed access to GLP-1 prescriptions, monitoring while on the medication, and a path to deprescription.
Choose one of two program options:
- Vida: Integrated, culturally competent behavioral health support and personalized care for people across the cardiometabolic spectrum
- Virta: Nutrition-first, provider-led care to reverse obesity and diabetes and promote sustainable weight loss
Partnering for a healthier future
The Blue Cross operating model is built on trust, transparency and access, resulting in a rating of the most trusted health plan for 15 years.11
With Blue Cross and Prime, you can be confident in programs and benefits that are reliable and cost-effective, delivering the medications and therapies needed for a healthier future. Through evolving pharmacy solutions and technology innovation, the partnership enables better health outcomes for employees and cost savings for employers. Our focus on controlling costs extends to new and emerging medication categories such as GLP-1s, so employers can be confident in our commitment to savings now and in the days ahead. It’s the care you expect from Blue Cross, enhanced by transformative pharmacy solutions from Prime.
For additional information, read our article about taming specialty drug costs or contact your Blue Cross representative.
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1 “Spending on Prescription Drugs Has Been Growing Exponentially.” Peter G. Peterson Foundation, March 2024.
2 Competitor X analysis, 2023.
3 Gleason P, Qiu Y. Blue Cross and Blue Shield of Minnesota: Pharmacy Benefit Analysis, December 2022.
4 Blue Cross and Blue Shield of Minnesota data, Q2 2021 – Q1 2022.
5 Blue Cross and Blue Shield of Minnesota data, 2023.
6 Prime Therapeutics data.
7 Blue Cross and Blue Shield of Minnesota data, 2024.
8 Blue Cross and Blue Shield of Minnesota data, Q4 2023 – Q3 2024.
9 Virta Health actuarial model projecting savings from the following categories: medical savings, GLP-1 savings, medical savings from office visits and labs.
10 Based on Vida’s book of business analysis of GLP-1 costs and cost savings is net of fees.
11 “Is a name you can trust.” (phone interviews conducted 2010 – 2013) and “Is a company I can trust.” (online interviews conducted 2014 – 2024), Brand Strength Measure Survey, Blue Cross Blue Shield Association.
KeepWell is a program offered through Prime Therapeutics, LLC, an independent company providing pharmacy solutions.
Vida is an independent company that provides weight management and medication management services.
Virta is an independent company that provides weight management and medication management services.