Pharmacy Coverage

Blue Shield’s integrated approach to pharmacy and medical coverage gives you a smarter way to manage prescription drug costs. Explore tailored savings strategies and tap into our innovative cost management programs — all designed to provide a high-quality member experience.

  • Saving with integrated plans

    Pharmacy coverage should work hand in hand with medical coverage to deliver better health outcomes for members and greater efficiencies for employers.


    A targeted approach to managing drug costs
    From well-designed formularies to strategic partners, we make sure you don’t leave any savings on the table.


    A single plan that’s easier to administer
    Integrating pharmacy and medical benefits makes your job simpler while driving greater value.


    A better experience for your employees
    Members receive more holistic, coordinated care with a single source of answers and support.

Our effective cost management strategies are saving employers $16-24 per member per month.

  • A better prescription drug cost management strategy

    Our unified approach to utilization and cost management aligns medical and prescription benefits. Doctors and pharmacists together find the best treatment for each patient at the best price possible.

    Our new Prime Formulary for self-funded benefit plans provides choice while maximizing savings

    Our Specialty Drug program provides over 40% savings on high-cost drugs in both pharmacy and medical benefits via our networks, manufacturer contracting, and utilization management

    Referrals to our Advanced Practice Pharmacist network saved employers $28M during a two-year period

    Blue Shield’s Prescription Savings Program is designed to improve medication adherence by offering members discounts on prescriptions if filled on time

  • A holistic approach for large employers

    Integrating pharmacy and medical coverage isn’t just about better outcomes and enhanced savings — it’s a simpler plan for employers to administer. We’ll work with you to tailor coverage to your company’s population so you can get the most out of every healthcare dollar.

    By integrating pharmacy and medical care, we save our clients $16-24 PMPM, compared to carve-out models

    Our lower cost benefit design, formulary, and network options provide flexibility to best meet your needs

    We offer cost stability and quality assurance based on proven, data-driven strategies, so you can plan ahead

    One account team for both pharmacy and medical means streamlined administration for you

  • A better member experience

    When doctors and pharmacists work together, members benefit with a cohesive treatment plan and, with our customer care site, a single point of contact to get their questions answered.

    We have a nationwide network of 66,000+ pharmacies, including all key national and regional chains and independent pharmacies

    Members have a seamless experience, with a single customer care team who answers both pharmacy and medical questions

    We provide coordinated case management for high-risk members (for instance, a cancer patient), helping them navigate treatment and services

    Our Advance Practice Pharmacists help close gaps in care, improving medication adherence and ultimately health outcomes

  • An innovative mindset

    We never stop reimagining how we can offer better health care. As we bring more pharmacy solutions to market, you and your employees will benefit from improvements we make to provide safe, equitable access to sustainably affordable prescription drugs.

    Blue Shield’s biosimilar program, which steers members to more affordable medications, has achieved an overall adoption rate of 58%, going as high as 85% for select drugs

    Our drug-cost transparency tool helps a doctor and patient decide in real time on the most appropriate, cost-effective medications, avoiding confusion or sticker shock later

    Our investment in CivicaRx has led to the launch of a prostate cancer drug that will cost no more than $171 a month, compared to its current $4,500 price tag; other drugs in the pipeline include insulin

    Blue Shield contracts with specialty and genetic therapy providers to reduce costs for employers and members alike

Need more information on pharmacy benefits?