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December 2018

ESI to be Michigan retail pharmacy network manager for our commercial business, starting Jan. 1, 2019

Blue Cross Blue Shield of Michigan and Blue Care Network are launching a new relationship with Express Scripts, or ESI, as our Michigan retail pharmacy network manager for our commercial business, starting Jan. 1, 2019. We’re making the change to remain as competitive as possible and to help make our integrated pharmacy benefit more affordable for customers. This change does not affect your patients’ pharmacy benefits.

Blue Cross already contracts with ESI for our out-of-state and Medicare Advantage pharmacy network management. ESI contracts with other Michigan health plans as well.

ESI manages a broad network in Michigan that’s nearly identical to Blue Cross’ existing network. Here are some key details:

  • More than 99.9 percent of Michigan pharmacies already belong to an ESI network arrangement for other Michigan health plans and accept ESI’s reimbursement arrangement for other Michigan health plans.
  • There are 2,400 pharmacies in the Blue Cross and BCN pharmacy network and all but approximately 30 belong to the National Plus pharmacy network managed by ESI. We will ensure that they’re offered an opportunity to join the ESI National Plus network.
  • ESI pharmacy network management does not affect our members’ prescription drug benefit design. As they do today, prescription benefits will continue to depend on a group’s benefit design selection.

This change is in direct response to customer needs and designed to deliver significant savings to our customers while maintaining access to a large network of pharmacies. Our customers and members have expressed concerns about the ever-increasing costs of prescription drugs. Helping to lower these costs through effective pharmacy benefit management is key to keeping employer-sponsored and individual health coverage affordable.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
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