Michigan Blues to change pharmacy benefit manager from Express Scripts to OptumRx

Blue Cross Blue Shield of Michigan and Blue Care Network have decided to change pharmacy benefit managers to help reduce prescription prices and more effectively deliver services to members.

The switch from St. Louis-based Express Scripts Inc. to Irvine, Calif-based OptumRx will take effect Jan. 1, 2022, for commercial individual and group members, and Jan. 1, 2023, for Medicare individual and group members, the Michigan Blues said in a statement.

“Preparations are already underway to manage the change, which will be a significant corporate project spanning more than two years,” said Blue Cross in a Jan. 6 internal memo that Crain’s obtained. “We’re working with a firm that specializes in pharmacy benefit manager changes to ensure a smooth transition with no disruption for our group customers and members.”

Express Scripts is owned by Cigna and OptumRx is owned by another rival insurer, Minnesota-based United Healthcare. Blue Cross extended its existing contract with Express Scripts in August 2018, several months before Cigna closed on its $54 billion deal to acquire the pharmacy benefit manager.

Blue Cross said it chose OptumRx after a competitive bid process that “led us to choose OptumRx as our PBM due to competitive pricing and performance guarantees” along with a capability to integrate overall health and wellness service benefits.

“Holding the line on steadily increasing pharmacy costs and ensuring members have access to the prescriptions they need are top priorities for Blue Cross,” said Daniel Loepp, Blue Cross’ president and CEO, in a statement. “We’re confident our partnership with OptumRx will help us move closer to reaching those goals through affordable, innovative solutions that improve care within our communities.”

Once the change is made, Blue Cross said OptumRx will add to the state’s largest health insurer’s existing programs, bringing new tools and digital technology designed to better manage overall drug spending and increase member engagement in pharmacy treatment.

For example, OptumRx will support administration of pharmacy claims, manage rebate contracting with pharmaceutical manufacturers, provide mail-order dispensing and manage Blue Cross’ pharmacy networks.

Blue Cross also has negotiated contracts with more than 68,000 pharmacies and also offers home delivery.

AllianceRx Walgreens Prime will continue as the preferred provider of specialty drugs for members, said Blue Cross in its internal memo.

“We conducted a separate RFP process for specialty pharmacy management and Walgreens provide to be the strongest partner, offering improved pricing and effective member supports,” Blue Cross said.

Blue Cross also said medication adherence programs with PillarRx and Sempre Health will not be affected by the change to OptumRx. Blue Cross said it will continue to manage its own drug list, or formularies, while making slight modifications using OptumRx’s expertise.

As the state’s largest insurer, Blue Cross serves 4.5 million people in Michigan and 1.6 million in other states. It has the largest network of doctors and hospitals in Michigan, with 152 hospitals and more than 33,000 doctors. About 3 million members are covered by the pharmacy benefit contract.

“We look forward to working together to better connect and integrate pharmacy support with medical programs to improve the whole health experience for Blue Cross members, care providers and employers, said John Prince, Optum Rx’s CEO, in a statement.

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