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Excellus BCBS’s pharmacy concierge program can yield savings

  • / Updated:
  • Staff Report 

Excellus BlueCross BlueShield’s innovative Pharmacy Concierge program has been making strides in enhancing medication safety while simultaneously reducing prescription drug costs for numerous employers.

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The program, chiefly designed for midsize and large employer groups, entails a team of clinical pharmacists from Excellus BCBS meticulously reviewing pharmacy claims. The goal is to identify and address issues such as unnecessary medications, incorrect dosing, safety concerns, and to propose cost-saving alternatives like generics or biosimilars, which are equally effective as their brand-name counterparts but often at a lower cost.

The program’s effectiveness is evident in the significant savings it has provided to organizations like Heritage Christian Services in Rochester, New York. Dan Ross, the Vice President of Corporate Compliance and Risk Management at Heritage Christian Services, highlighted the program’s benefits, noting savings of nearly $100,000 in pharmacy costs in 2022 and an expectation of even greater savings in 2023. In 2022 alone, the Pharmacy Concierge team successfully eliminated $11 million in unnecessary or inappropriate pharmacy spending across nearly 900 employers, reviewing more than 7.4 million claims for potential safety and savings opportunities.

The program’s success stories include identifying patients who were prescribed either redundant or incorrect medications, and facilitating adjustments in therapy in consultation with prescribing physicians. This has led to both improved patient safety and significant financial savings for patients and their employers. For example, the program identified a member prescribed the incorrect dosage of an antidepressant and suggested a lower-cost generic alternative, resulting in an annual savings of $3,500 for the patient. Additionally, a consortium of upstate New York school districts reduced pharmacy spending by over $1 million after participating in the program. Mona Chitre, Chief Pharmacy Officer at Excellus BCBS, emphasizes that all medication decisions are ultimately made by the member’s provider in consultation with the patient, ensuring that care remains personalized and effective.