At Blue Cross and Blue Shield of New Mexico, we know that it’s more important than ever to better manage pharmacy costs without compromising health outcomes or support for your employees. BCBSNM is a leader in transforming how pharmacy benefits are delivered through a unique, competitive and integrated solution.
Prescription Drug and Pharmacy Benefits
Better Outcomes
Clinical programs - backed by real-time, integrated data - support providers in optimizing care management and improving member health resulting in 28% lower inpatient drug utilization.1
Lower Costs
Effective programs target medication adherence, manage utilization, and leverage real-time medical and pharmacy data to drive down costs by an average savings of $516 per member per year.1
Member Engagement
Programs leverage real-time pharmacy and medical data to engage members, leading to lower costs and better outcomes. Members are 29% more likely to be engaged by care management.1
Aligned Incentives
We offer integrated custom solutions that support the goals of your business and the needs of your employees and their families.
Better Outcomes: Real-Time Data & Outreach
Integrating Medical and Pharmacy Data
Approaching members holistically across pharmacy, medical and behavioral care results in 15% lower ER utilization.1
Reaching Members When It Matters
Providing digital tools that increase consumer shopping and improve access.
Leveraging Real-Time Data
Engaging with members with outreach and targeted programs that close clinical gaps.
Lower Costs: Effective Programs and Partnerships
Flex AccessTM
FlexAccess unlocks access to copay assistance programs across multiple dispensing channels, including retail pharmacies. Savings opportunities on targeted drugs deliver up to $9 per member per month in gross savings.2
HighTouchRxTM
Our pharmacist outreach program integrates claims data to identify drug therapy optimization opportunities. In six months, this outreach resulted in significant savings.
CivicaScriptTM
Our partnership with CivicaScript brings affordable versions of high-priced generic medicines to the market, resulting in significant savings. In 2022, CivicaScript launched a prostate cancer treatment medication for less than $200.
Member Engagement: Removing Barriers
MyBlueRx App
Our MyBlueRx pharmacy app makes it easy for members to manage medications, prescription benefits and cost savings opportunities.
Medication Finder
Members receive proactive notifications on prescription savings opportunities. Those who enroll and switch to a lower-cost alternative save on average of $573 annually.3
Aligned Incentives: Our Incentives are Clear and Fully Aligned With Your Business Goals
While our competitors are maximizing profits for their shareholders, we are maximizing value for our customers. Value is created through integrating benefits, innovation programs and partnerships, and engaging with members.
Our Commitment
Our customers and members, not shareholders
Our Focus
Flexibility and innovation
Our Motivation
Higher quality of care and lower costs for you and your employees
An Integrated Approach that Delivers
Our complete pharmaceutical management strategy links pharmacy and medical benefits to lower overall health care costs, improve health outcomes and deliver an unrivaled member experience.
Why Connect Pharmacy and Medical Benefits?
A recent study by HealthScape Advisors tracked 6.4 million members for three years. The study found that ASO groups who connect medical and pharmacy benefits have significantly lower medical costs.
Get More From Your Pharmacy Plan
Discover pharmacy benefits, tools, and resources that help manage costs while meeting all your business needs. Give employees more choices while retaining the benefits and availability for nearly all branded prescription drugs with prescription drug coverage and programs designed to help simplify experiences and lower costs.
National Pharmacy Networks
- Reduced Pharmacy Costs – Purchasing power and discounts keep costs low and provide greater savings and improved access for you and your employees
- Expanded Access – National and regional chains, plus local independent pharmacies
- Choice – Extended Supply Network with 30-day and 90-day supply options improves adherence and access, and helps reduce costs.
Controlled Substance Program
We maximize positive health outcomes with a coordinated approach among medical and pharmacy providers, drug-utilization review and risk identification outreach.
Specialty Review Unit
Specialty medications are those used to treat serious or chronic conditions. As the price and utilization of these medications continue to escalate, we can help with our Specialty Review Unit.
Preventive Drug Programs
The HDHP-HSA and ACA Preventive Drug Programs are benefits that groups can choose if they have High Deductible Health Plans (HDHP). These programs help remove barriers to access and encourages adherence to medications, resulting in improved health outcomes.
Clinical Programs
Evidence-based clinical programs include:
- Guided Health – A proven medication outreach program addressing adherence, overuse and safety concerns.
- Utilization Management – Offering over 100 programs like prior authorization, step therapy and drug dispensing limits.
- Pharmaceutical Care Management – Uses claims data to identify harmful interactions, ensure adherence and identify gaps in care, and uncover cost-savings.
Total Drug Management
A variety of solutions address the rising cost of drugs under the medical benefits including medical policies, infusion site of care, channel management, and more.
Ready to get started?
Let us know how we can help.
1 Connected Benefits Study Summary
The results of BCBSNM’s Integrated Pharmacy study are the product of a robust analytical exercise. The study was conducted across five markets: Illinois, Texas, Oklahoma, New Mexico, and Montana. In aggregate, 545 findings were identified as statistically significant and favorable for carve-in (connected) groups. The study population consisted of 1,530 carve-in groups and 514 carve-out groups, with 2.6M and 4.5M members within each population, respectively, in 2021. The methodology and results of this study have been reviewed and validated by Scott Allen, a credentialed health care actuary who is a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries.
Results may vary and performance may be driven by client-specific benefit design and program engagement.
2 Prime Therapeutics internal data from self-funded ASO book of business client data, 2021. Savings may differ depending on current benefit design.
3 Medication Finder data based on Rx Savings SolutionsTM fiscal year 2021 analysis of members who chose a suggested lower-cost prescription option.
Prime Therapeutics LLC (Prime) is a pharmacy benefit management company, contracted by BCBSIL to provide pharmacy benefit management and related other services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.