Price Edge service expands to include Blue Cross PPO members

As of Jan. 1, 2024, all Blue Cross Blue Shield of Michigan and Blue Care Network commercial group pharmacy plans include Price Edge, a service that automatically finds the lowest price available on medications when members fill their prescriptions. When the program launched in June 2023, Price Edge was only available to BCN commercial pharmacy members of self-funded and fully insured groups. Through the first four months of BCN’s Price Edge program, it reached $1 million in total member out-of-pocket savings.

Managing drug costs

The Price Edge program is one component of Blue Cross’ ongoing efforts to help manage skyrocketing drug costs.

“We hear all the time from our members how unaffordable their prescription drugs are becoming – so we did something about it,” said Kathryn Levine, president and CEO of Blue Care Network. “We launched Price Edge to make our plans more affordable and convenient for our members. While there are hundreds of drug discount programs to help members save money, people don’t have the time and resources it takes to sort through all those programs, find the best deal and take all the steps required to obtain the discount. With Price Edge, all that work is handled for the member, automatically and in a matter of seconds.”

How it works

Price Edge compares prices for select nonspecialty, generic medications that are available directly to consumers with drug discount cards against those available through their health care benefits.

If there’s a lower cost to members outside of their insurance benefits, Price Edge automatically applies that price, regardless of whether the medication is covered.

If the drug is covered by the member’s plan: The claim is submitted, and the member automatically receives a competitive price. The member saves money, and the cost counts toward his or her deductible and out-of-pocket maximum.

If the drug isn’t covered by the member’s plan and would have rejected as noncovered: The claim now shows as paid, and the following point of sale message appears: Drug not covered. Processed w/discount program. Member cost does not apply to benefit deductible or OOPM.

The member fills the prescription at the discount and saves money. The cost is treated as a noncovered claim and doesn’t count toward his or her deductible and out-of-pocket maximum. The member gets a better price, even though it’s not covered through his or her benefit. Claims for these prescriptions may be listed on the member’s claim summary without a reminder that they aren’t covered.

In addition to saving members money, Blue Cross hopes the service will help with medication adherence.

“Drug costs are increasing an average of 5%, a rate higher than the average wage increase. We know that the affordability of drugs can be a barrier for people to take their medications as prescribed,” said Atheer Kaddis, vice president of Pharmacy Services and chief pharmacy officer at Blue Cross. “Price Edge helps Blue Care Network members keep their costs down and provides some relief whether at the cash register or online mail order. Every time they go to the pharmacy, they pay the lowest price available to Blue Care Network members for their medications, which we believe will help with adherence.”

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.