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June 2021

Pharmacy Opportunities Focus updated for Spring 2021

The Pharmacy Opportunities Focus document, updated for spring 2021, has incorporated suggestions based on recent significant manufacturer drug price increases. This resource can serve as a quick reference guide for a variety of situations, such as when considering multiple drug options at the point of care or performing an evaluation of pharmacy claims data to identify high-cost drugs and their lower-cost preferred alternatives.

Below are additional suggestions when looking through pharmacy data to identify potential cost-saving opportunities:

  • Moving from brand-name medications to generics. Compare pharmacy claims data with the drug lists.**
  • Leveraging the preferred alternatives of a member’s respective drug list at the point of care. Download the free ScriptVision™ Physician app through the App Store® for your iPhone or iPad. In real time, see the member’s out-of-pocket costs, any plan requirements (for example, prior authorization, step therapy and quantity limit) and lower-cost alternatives.

    If real-time prescription benefit check is enabled in your electronic health record or electronic medical record system, use this function to see the member’s out-of-pocket costs and specific plan requirements.
  • Improving the generic prescribing rates of primary care provider. Use the physician profile report for details on certain drugs or members.
  • Monitoring specialists who prescribe brand-name drugs when a generic is available or nonpreferred drugs when preferred alternatives are available. Identify the specialists and then reach out to them for discussion.

The suggestions above are general guidelines. Use clinical judgment to determine the most appropriate option for each patient’s specific circumstances.

For a step-by-step guide on how to navigate Health e-Blue℠ to obtain pharmacy claims data, as well as how to generate the pharmacy profile report of a primary care provider, refer to the Pharmacy Opportunities Focus: Health e-Blue Pharmacy Guide on the Health e-Blue website.

Note: The information in this article applies to all members with Blue Cross Blue Shield of Michigan and Blue Care Network commercial pharmacy plans.

**The drug lists are updated monthly to reflect new drug approvals, new safety or efficacy data and clinical guideline updates. Refer to the online documents for the most up-to-date versions.

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 2020 American Medical Association. All rights reserved.