Blue Shield Reimagines Pharmacy Care
Carrier Updates
Thursday, February 27 2025
February 19, 2025 by Matt Gibbs- At Blue Shield of California, we strive to ensure all Californians have access to high-quality health care at an affordable price. Delivering affordable, transparent pharmacy care is a primary component of that mission.
Pharmacy is often the most frequent touchpoint within our healthcare journey. Yet, for many of us, the experience is costly, opaque and hard to navigate. That’s why Blue Shield of California set out to reimagine the prescription drug experience with the goal of building a pharmacy ecosystem that prioritizes better value for our members.
Much of our initial work has focused on challenging the traditional supply-chain model, transforming how different players in this complex ecosystem work together — all in the service of our members. From rethinking these intricate models to working with various collaborators to lower drug costs, we’re laying the groundwork now for a more sustainable and patient-forward system.
What’s happening behind the scenes?
Reimagining pharmacy care requires addressing the structural issues that have long plagued our healthcare system. One of the most significant shifts is breaking away from the traditional pharmacy benefit manager (PBM) model — a model that has given rise to three major PBMs, which together control 80% of the market.
While their mandate is to lower drug costs for employers and health plans, PBMs instead have operated as opaque intermediaries within the pharmacy supply chain. They profit from complex pricing structures that often increase the cost of drugs for patients. These conglomerates draw negative attention for practices like prioritizing medications that deliver the most profit to themselves, tacking on hidden fees, and pocketing part of the discounts they negotiate with drug manufacturers and retail pharmacies — savings that should be passed on to consumers. (Read more about how PBMs affect your health care here.)
This model doesn’t work for anyone but PBMs. It doesn’t work for health plans or employers; it’s not good for drug manufacturers or pharmacies. Most importantly, it’s bad for consumers.
Because of this, Blue Shield set out to unbundle the services traditionally handled by PBMs and instead build a new pharmacy service model that allows Blue Shield to provide members and employers with accurate drug pricing for truly informed decisions.
You might already be seeing these changes. Last year, for example, we announced a collaboration with drug manufacturer Fresenius Kabi and Evio Pharmacy Solutions to purchase a Humira biosimilar for a transparent net price of $525 per monthly dose — far less than the approximately $2,100 monthly cost previously associated with Humira when traditional PBMs are involved. Now, most Blue Shield members can access this biosimilar option at a fraction of the cost.
As part of that work, we’re leveraging state-of-the-art technology to make the pharmacy care experience much more convenient and streamline how prescription drugs are delivered to our members. Here’s what you can expect in the coming year.
To Read More Click Here
Pharmacy is often the most frequent touchpoint within our healthcare journey. Yet, for many of us, the experience is costly, opaque and hard to navigate. That’s why Blue Shield of California set out to reimagine the prescription drug experience with the goal of building a pharmacy ecosystem that prioritizes better value for our members.
Much of our initial work has focused on challenging the traditional supply-chain model, transforming how different players in this complex ecosystem work together — all in the service of our members. From rethinking these intricate models to working with various collaborators to lower drug costs, we’re laying the groundwork now for a more sustainable and patient-forward system.
What’s happening behind the scenes?
Reimagining pharmacy care requires addressing the structural issues that have long plagued our healthcare system. One of the most significant shifts is breaking away from the traditional pharmacy benefit manager (PBM) model — a model that has given rise to three major PBMs, which together control 80% of the market.
While their mandate is to lower drug costs for employers and health plans, PBMs instead have operated as opaque intermediaries within the pharmacy supply chain. They profit from complex pricing structures that often increase the cost of drugs for patients. These conglomerates draw negative attention for practices like prioritizing medications that deliver the most profit to themselves, tacking on hidden fees, and pocketing part of the discounts they negotiate with drug manufacturers and retail pharmacies — savings that should be passed on to consumers. (Read more about how PBMs affect your health care here.)
This model doesn’t work for anyone but PBMs. It doesn’t work for health plans or employers; it’s not good for drug manufacturers or pharmacies. Most importantly, it’s bad for consumers.
Because of this, Blue Shield set out to unbundle the services traditionally handled by PBMs and instead build a new pharmacy service model that allows Blue Shield to provide members and employers with accurate drug pricing for truly informed decisions.
You might already be seeing these changes. Last year, for example, we announced a collaboration with drug manufacturer Fresenius Kabi and Evio Pharmacy Solutions to purchase a Humira biosimilar for a transparent net price of $525 per monthly dose — far less than the approximately $2,100 monthly cost previously associated with Humira when traditional PBMs are involved. Now, most Blue Shield members can access this biosimilar option at a fraction of the cost.
As part of that work, we’re leveraging state-of-the-art technology to make the pharmacy care experience much more convenient and streamline how prescription drugs are delivered to our members. Here’s what you can expect in the coming year.
To Read More Click Here