A woman holding a small child offers her credit card at a pharmacy counter

Prescription Drug and Pharmacy Benefits

With 50% of Americans having at least one prescription1, drug coverage is a vital benefit to your client's employees. But when prescriptions alone account for nearly a third of total health care costs2 employers struggle with how to best control costs. At Blue Cross and Blue Shield of Montana (BCBSMT), we know it’s more important than ever to better manage pharmacy costs without compromising health outcomes or member support. With BCBSMT, your clients don’t have to choose between positive outcomes and lower costs.

An Approach that Delivers

BCBSMT is a leader in transforming how pharmacy benefits are delivered through a unique, competitive and integrated solution. Our complete pharmaceutical management strategy links pharmacy and medical benefits to lower overall health care costs, to improve health outcomes and to deliver an unrivaled member experience.

Why Connect Pharmacy and Medical Benefits?

BCBSMT is driving savings with connected benefits and holistic care management.

The Value of Integrated Pharmacy and Medical Benefits

Learn why an integrated pharmacy and medical benefits strategy could control costs for your client and create a better member experience for their employees.

Get More From Our Pharmacy Plans

Our pharmacy benefits, tools, and resources help manage your client's costs while meeting their needs. Employees have access to nearly all branded prescription drugs and to programs designed to help simplify experiences and lower their out-of-pocket costs.

Member Rewards – RX4

A game-changing rewards program that drives savings, transparency and improved health. This seamless digital experience encourages members to select lower cost drug identified through its search engine, resulting in lower costs for the life of the prescription and a cash reward for switching. Employers see reduced health care spend with increased use of lower-cost drugs.

National Pharmacy Networks

  • Reduced Pharmacy Costs – Purchasing power and discounts keep costs low and provide greater savings and improved access for your client and their employees
  • Expanded Access – National and local access across all networks (based on plan design) includes numerous independent pharmacies as well as national and regional chains, offering broad access or urban, suburban and rural members
  • Choice – Extended Supply Network with 30-day and 90-day supply options (per plan design) improves adherence and access, and helps reduce costs. Other networks include Vaccine Administration network and Specialty network

Controlled Substance Program

We want to maximize positive health outcomes for members by working together toward a coordinated approach among medical and pharmacy providers, at no additional charge to your client. Ask about our concurrent drug-utilization review and risk identification outreach for opioid misuse, and many other options.

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.

Specialty Pharmacy Program

Specialty medications are those used to treat serious or chronic conditions. Specialty medications that fall under the medical benefit are the fastest-growing segment of health care spend. As the price and utilization of these medications continue to escalate, it becomes increasingly necessary to ensure safe and effective medication use while managing costs. We can help with our Specialty Review Unit (SRU).

Medication Finder

The Medication Finder enables members to make informed decisions on lower costs for their medication, resulting in savings all around. Members who enroll and switch to a lower cost alternative save an annual average of $573, and employers save an annual average of $393 per member when the member chooses a lower cost drug.3

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 plans allow clients to customize their benefits on some chronic disease states and navigate patients to preferred drugs to reduce costs. The program also removes barriers to access and encourages adherence to medications, resulting in improved health outcomes.

Clinical Programs

These programs are rooted in evidence-based medicine, leading to a path for better outcomes and costs. They provide a suite of clinical programs to optimize clinical outcomes while addressing the needs of members. Programs include:

  • Guided Health – A proven medication outreach program addressing adherence, overuse and safety concerns.
  • Utilization Management – Offering over a hundred programs at no additional charge like prior authorization, step therapy and drug dispensing limits.
  • Pharmaceutical Care Management (PCM) – A value-added program that uses medical and pharmacy claims data to analyze members’ prescription drug usage and overall treatment to identify harmful interactions, ensure medications are taken as prescribed and identify gaps in care, while uncovering possible cost-savings.

Pharmacy Benefits Tier Design

BCBSMT plans have a variety of tier options -- from no tiers up to six. A tiered design gives employers the opportunity to save money by choosing prescription medications that are less costly, but equally effective.

1 2020 Therapeutic Drug Use data, Centers for Disease Control and Prevention, CDC.gov
2 Source: Internal Prime data, 2019.
3 Based on Rx Savings SolutionsTM fiscal year 2021 analysis of members who chose a suggested lower-cost prescription option.
4 Not available for all groups

Prime Therapeutics LLC (Prime) is a pharmacy benefit management company, contracted by BCBSMT to provide pharmacy benefit management and related other services. BCBSMT, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.

Last Updated: Nov. 28, 2023