Hospital and Physician Update

Blue Cross develops programs to improve medication adherence and save members money

As you know, medication adherence is extremely important for controlling disease progression and maintaining long-term health and well-being. To improve medication adherence, Blue Cross Blue Shield of Michigan and Blue Care Network work with independent companies to address the issue of high-cost drugs, which can negatively affect medication adherence. We take a close look at drugs available under both the specialty and retail pharmacy benefits, along with certain maintenance medications for diabetes, cardiovascular and respiratory drugs.

Here are two programs you may not be aware of that not only encourage medication adherence but save members money.

This program helps commercial members get copay assistance from drug manufacturers for specialty and high-cost drugs at retail and specialty pharmacies. It started in July 2020, as an opt-in option for our self-funded groups, and is generating an average of 25% savings on the cost of select drugs. In January 2021, the program was also incorporated into our fully insured pharmacy plans. Members will save on approximately 300 specialty and high-cost drugs.

Blue Cross and BCN members are eligible for savings based on their claims history for drugs included in the program. PillarRx sends introductory information to eligible members and then calls to enroll them and explain how the program works, what to expect at the pharmacy and answer questions. PillarRx communicates with pharmacies to send members’ discount information. After members are enrolled, there are no other steps they need to take to save on their specialty and other high-cost medications in the program.

The Drug Adherence Discount Program focuses on certain drugs used to treat common chronic conditions where following doctors’ orders can improve health and prevent serious complications. This coupon program is expected to expand over time and currently includes select medications used to treat:

The program saves our members money while also increasing their medication adherence. The program has already saved $2.7 million. Also, the proportion of members who adhere to their medications is 37 percentage points higher for those who participate in the program compared to those who don’t.

The program’s now a standard benefit for all members with commercial Blue Cross pharmacy coverage.

Blue Cross identifies eligible members who have filled a prescription for a qualifying medication. Then Blue Cross and Sempre Health send members information about the program and enrollment through letters, postcards and emails. Once enrolled, Sempre Health will send text message or email reminders, based on member preferences, when it’s time for the member to fill his or her prescription every month. When the member refills and picks up the prescription on time, he or she will earn a discount on the copay. The member simply gives the pharmacist a discount code from the text messages or emails. Monthly discounts increase as the member refills prescriptions on time.

Blue Cross started the Drug Adherence Discount Program in late January 2020. By June 2021:

Did you know...

The High-Cost Drug Discount Optimization Program, powered by PillarRx, generates an average of 25% savings on the cost of select drugs. Members save on approximately 300 specialty and high-cost drugs.
The Drug Adherence Discount Program, powered by Sempre Health, has already saved $2.7 million. And the number of members who adhere to their medication is significantly higher for those who participate in the program.