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.
Pharmacy Coverage
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.
A targeted approach to managing drug costs
From well-designed formularies to strategic partners, we make sure you don’t leave any savings on the table.A single plan that’s easier to administer
Integrating pharmacy and medical benefits makes your job simpler while driving greater value.A better experience for your employees
Members receive more holistic, coordinated care with a single source of answers and support.
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 how we can offer better health care. As we bring more pharmacy solutions to market, you and your employees will benefit from improvements we make to provide safe, equitable access to sustainably affordable prescription drugs.
•Our biosimilar program, which steers members to more affordable medications when biosimilars are preferred, has achieved an overall adoption rate of 80%, exceeding 90% in some drug classes
•We provide a drug-cost transparency tool that helps a doctor and member 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
•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. With a focus on cost transparency and simplicity, we are improving the pharmacy experience.
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Speaker 1:
Imagine a simpler way to get prescriptions for less. With Blue Shield of California, you'll have the tools to access affordable drugs more easily, compare costs and find the best deal on your medications with Price Check My Rx. Whether it's a lower-cost alternative or a better price at another pharmacy, you can easily explore your options. You can also choose to receive a text alert, letting you know when a less expensive alternative drug is available. And finding a nearby pharmacy is simple through our pharmacy locator with filters to quickly narrow down your search.
You can also save time and money with Amazon Pharmacy Home Delivery straight to your doorstep in two to five days at no extra charge. With a focus on cost transparency and affordability, our pharmacy tools make it easy to see if you're getting your prescriptions for the best value. Just log into your online account or register now at blueshieldca.com.
Learn more about our cost-saving programs
Pharmacy — DownloadEffective solutions to managing the cost of gene and cellular therapies
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Pharmacy — DownloadBlue Shield streamlines management of drugs covered by medical benefits
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Pharmacy — DownloadBlue Shield aims to cut costs, improve outcomes for chronic conditions
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