Blue Shield: Pharmacy Care Reimagined

The cost and accessibility of drugs have become unavoidable challenges for the healthcare industry – and anyone needing to fill their prescription. Plans, providers, and patients have been poorly served by the traditional Pharmacy Benefit Manager (PBM) model that too often drives up cost, limits choice, and obscures information. Beyond drugs’ efficacy – which can be remarkable when matching the right drug with the right clinical need – the member experience in accessing prescriptions has declined, despite prescription drugs being the most prevalent therapeutic intervention. Given that most Americans take at least one prescription drug annually, the process must work better. 

There is now reason for optimism. Several pioneering companies are taking groundbreaking actions to lower costs and improve patient experience through new models that reimagine the traditional pharmaceutical supply chain and pricing structure. They are lowering costs for employers and members, expanding beyond overreliance on PBMs, building new value-based models, and using transparency to enhance informed choice and member experience at the pharmacy counter and through home delivery.

This is just the beginning. The opportunity to create a better, more sustainable pharmaceutical supply chain faces challenges from players with entrenched interests. Achieving real savings and member experience improvements in California and beyond calls for innovative thinking and dedicated implementation.  The momentum is there to fix what’s broken and the best and brightest companies are already leading the way.

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