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 New Mexico, we know it’s more important than ever to better manage pharmacy costs without compromising health outcomes or member support. With BCBSNM, your clients don’t have to choose between positive outcomes and lower costs.

An Approach that Delivers

BCBSNM 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?

BCBSNM 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 and create a better employee experience.

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 with prescription drug coverage and programs designed to help simplify experiences and lower costs.

National Pharmacy Networks

  • Reduced Pharmacy Costs – Purchasing power and discounts keep costs low and provide greater savings and improved access for group clients and their employees
  • Expanded Access – National and regional chains, plus local independent pharmacies
  • Choice – Extended Supply Network with 30-day and 90-day supply options improves adherence and access, and helps reduce costs

Controlled Substance Program

We maximize positive health outcomes with a coordinated approach among medical and pharmacy providers, drug-utilization review and risk identification outreach.

Specialty Review Unit

Specialty medications are those used to treat serious or chronic conditions. As the price and utilization of these medications continue to escalate, we can help with our Specialty Review Unit.

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 programs help remove barriers to access and encourages adherence to medications, resulting in improved health outcomes.

Clinical Programs

Evidence-based clinical programs include:

  • Guided Health – A proven medication outreach program addressing adherence, overuse and safety concerns.
  • Utilization Management – Offering over 100 programs like prior authorization, step therapy and drug dispensing limits.
  • Pharmaceutical Care Management – Uses claims data to identify harmful interactions, ensure adherence and identify gaps in care, and uncover cost-savings.

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.

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 BCBSNM to provide pharmacy benefit management and related other services. BCBSNM, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.