Excellus BlueCross BlueShield
Did you know that prescription drug costs in the U.S. are rising faster than inflation? For businesses, that means higher expenses and tough choices. Here’s the good news: cutting costs doesn’t have to mean cutting benefits. With smart pharmacy strategies, you can control spending while ensuring your employees get the medications they need.
These five proven approaches, available through Excellus BlueCross BlueShield (BCBS), can help you manage costs without compromising care.
1. Smart formulary management
A well-structured formulary keeps costs down while ensuring employees have access to the medications they need. Having a rigorous review process in place helps ensure drugs are placed appropriately on our formulary, weighing clinical outcomes and cost-effectiveness. Prior authorizations, managed by unbiased pharmacists, also help prevent unnecessary spending while maintaining quality care.
2. Reducing waste and unnecessary spending
One of the biggest drivers of rising health care costs is pharmacy waste. Employers can tackle this with strategies like high-cost claim reviews, splitting initial fills of expensive specialty oncology medications, and promoting value-based drug solutions. Programs like our dedicated Pharmacy Special Investigations Unit (SIU) mitigate risk for employer groups by stopping potentially fraudulent activities as they occur.
3. Managing the growing GLP-1 trend
GLP-1 medications, originally approved for diabetes, have also seen a surge in use for weight loss. While these medications can be beneficial for the right patients, inappropriate prescriptions drive up costs. A structured prior authorization process ensures that GLP-1 prescriptions align with medical guidelines, preventing unnecessary spending while ensuring appropriate patient access. Businesses using this approach have already seen significant savings. Groups leveraging our Excellus BCBS formularies had an average $13.64 PMPM savings on GLP-1 weight loss drugs compared to that of a national PBM formulary1.
4. Optimizing specialty drug benefits
Specialty drugs account for a large portion of pharmacy expenses, increasing medical costs, but a strategic shift can help. Shifting certain specialty medications from the medical benefit to the pharmacy benefit unlocks lower net costs—helping you save money while keeping care uninterrupted for employees.
5. Better cancer care management
Advancements in cancer treatments bring better outcomes—but also rising costs. Employers can manage these expenses by leveraging strategic partnerships that provide evidence-based oncology care. High-cost claims can be reviewed with expert input to ensure employees receive the best treatment at the lowest cost.
Take control of pharmacy costs
Employers don’t have to choose between saving money and supporting employee health. By implementing these five strategies, businesses can create a sustainable pharmacy benefit plan that benefits them and their employees.
Together, these five strategies make up our core pharmacy suite, which helps employers save an average of $27.77 PMPM2. Want to explore cost-saving opportunities for your organization? Visit ExcellusForBusiness.com or contact your account representative today.
Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association.
1 Based on 2024 Health Plan Data
2 Based on 2023-2024 Health Plan Claims Data.