Pharmacy Opportunities Focus updated for spring 2022

Pharmacy Opportunities Focus has been updated for spring 2022. The document has drug target examples based on recent, significant increases in manufacturer drug prices. Pharmacy Opportunities Focus can serve as a quick reference for multiple scenarios, such as when you’re considering 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 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. 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 a primary care provider. Use the physician profile report for details on certain drugs or patients.
• 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.