Blue Daily
Articles
The Pharmacy Solutions Helping Blue Cross Rewrite the Prescription for Affordability
- Blue Cross held pharmacy spending flat in 2025 by expanding a biosimilar program that cut monthly costs on drugs like Humira and Stelara from about $10,400 to less than $1,000, saving members more than 90% off list prices.
- A partnership with Evio Pharmacy Solutions created a direct‑purchasing model that bypassed traditional PBMs, lowering prescription and specialty drug prices to less than 10% of brand‑name costs.
- The insurer plans to launch an exclusive specialty pharmacy program in 2026 for large‑group fully insured plans, aiming to keep future high‑cost therapies affordable while protecting members and employers.
Blue Cross Blue Shield of Michigan Partners with WellSky® and tango to Deliver High Quality Post-Acute Care Management
- Together, tango and WellSky provide a data-driven approach to addressing long standing challenges in post-acute care (PAC).
- PAC services support recovery through rehabilitation, skilled nursing, wound care and other interventions that help our members recover confidently in their home.
- The WellSky-tango partnership aligns with BCBSM values by providing a prospective, episodic reimbursement model that also includes value-based incentives for home health care providers.
Blue Care Network’s Primary Care Physician Focus Network Expands Into 11 New Counties for the 2026 Plan Year
- BCN's PCP Focus network could be a good fit for those who need assistance in managing their general health, getting timely preventive care and receiving annual physicals.
- It is a plan worth exploring if you expect to be on a tight budget in the coming year.
- Individuals can choose from a list of primary care physicians that provide quality care and a high level of efficiency, both of which help lowers costs and keep health care affordable for everyone.
- We have expanded our list of eligible counties for 2026, and in doing so, have expanded our service area footprint by 55% for 2026.
Blue Cross Blue Shield of Michigan Partners with Corewell Health to Improve Several Areas of In-Hospital Patient Care
- In June, Blue Cross and Corewell announced a new agreement that will keep Corewell facilities in the Blue Cross network through 2030.
- Blue Cross and Corewell Health are putting a focus on improving several targeted areas of patient care.
- Those areas of include in-hospital fall and hip-fracture rate, post-operative sepsis rate and more.
Biosimilars Save Members More Than 90% Over Brand-name Specialty Drugs in 2025
- The Blue Cross Blue Shield of Michigan biosimilar program is saving members more than 90% off the list price of high‑cost drugs such as Humira and Stelara, cutting monthly costs from roughly $10,400 to less than $1,000.
- The shift to biosimilars could generate up to $50 million in savings for employer groups and members this year, with 99% of Humira and Stelara users now on the lower‑priced alternatives.
- Partnerships with Evio Pharmacy Solutions and a limited‑distribution specialty network enable home delivery and negotiated pricing that accelerate adoption of biosimilars.
Blue Cross Partner CivicaScript Offers Generic Drugs at Significant Savings
- BCBS partner CivicaScript develops, manufactures and distributes common high-price generic prescription drugs for a fraction of what many consumers otherwise pay.
- CivicaScript recently released a version of generic capecitabine, which is about $1,500 per month less than versions available from other distributors.
- CivicaScript's approach could significantly lower members’ out-of-pocket costs for deductibles and copayments, while also reducing costs for group customers and insurers.
What’s Changing in Michigan’s Health Insurance Market — and What It Means for You
- Blue Cross Blue Shield of Michigan remains committed to offering plans in all 83 counties, ensuring continued access to affordable, high-quality care.
- Enhanced Premium Tax Credits (EPTCs) — temporary federal subsidies that lowered health insurance costs for millions of Americans — are set to expire.
- With EPTCs set to end, insurers are adjusting rates to account for reduced federal funding, rising medical costs, and increased demand for care.
- Several insurers will no longer offer ACA/Marketplace plans in Michigan for the 2026 coverage year, leaving an estimated over 200,000 people needing new plans.
The Detroit News Reports on BCBSM Affordability Efforts
- Upstream health care prices continue to grow more expensive — and this trend is showing up downstream in Michigan’s health insurance premiums.
- The imbalance between claims paid and premiums collected is driving double-digit premium increases for 2026.
- A recent article from The Detroit News features comments from experts in the health care and health insurance field regarding the impact of the claims imbalance, hospital consolidation and rising prescription drug prices, and how each affect affordability.
Blue Cross Collaborative Care is Your One-Stop Shop for Whole Person Health
- Physical health and mental health are closely related. When physical and mental health issues compound, your whole person health suffers.
- With Blue Cross Blue Shield of Michigan’s Collaborative Care model, primary care and OB/GYN practices integrate mental health services into their practices.
- Integrating care streamlines information processes, which reduces administrative overhead and associated costs.
- With Collaborative Care, your PCP’s practice can connect you to the right services based on recommendations from their behavioral health consultant.
What You Can Do to Limit Your Spend on Health Care and Health Insurance
- Blue Cross Blue Shield of Michigan and Blue Care Network offer no-cost preventive care services, including annual physicals and screenings, to help detect health issues early and avoid more expensive problems later.
- The Blue365 discount program offers members savings on gym memberships, fitness gear and healthy living services, making it easier to prioritize health without breaking the bank.
- Living a healthy lifestyle, using a Health Savings Account and taking advantage of preventive care can help individuals manage healthcare costs and reduce the financial burden on the healthcare system.
Taking Control of Your Spine and Joint Health: A Proactive Approach
- More than half of adults ages 18 and older are impacted by musculoskeletal (MSK) conditions.
- A healthy MSK system allows you to move freely, maintain your independence, and enjoy life to the fullest.
- Common conditions that can impact your MSK system include herniated discs, arthritis, osteoporosis and tendinitis.
- BCBSM and BCN offer information and programs to help you and your loved ones enjoy a life of mobility, flexibility and comfort.
Detroit Free Press: Health Care Costs Are Rising — and Michigan Businesses & Employees Are Feeling the Strain
- High drug prices, greater utilization and higher provider rates are causing insurers to pay out more in claims than they collect in premiums.
- Rising premiums are slowing the hiring process for small businesses.
- Blue Cross is tackling affordability by working to bring down the price of prescription drugs, partnering with providers to reward value over volume and investing in healthier communities.
What is Blue Cross Doing to Prevent Health Care Fraud?
- Financial losses due to health care fraud account for 3% to 10% of health care costs.
- Health care fraud takes on many forms, including durable medical equipment, services not rendered, telemarketing fraud and more.
- More than 100 doctors have been charged with health care fraud in Michigan alone over the last decade.
- If you suspect fraud, you can call the Blue Cross toll-free Fraud Hotline at 844-STOP-FWA.
What to Know About Open Enrollment Through Your Employer
- Review your medical history, consider upcoming services and consult with your primary care provider to determine the type of coverage you require.
- Compare premiums, out-of-pocket costs and coverage details among available plans, including HMO and PPO options.
- Look into Flexible Spending Accounts or Health Savings Accounts to set aside pre-tax funds for eligible medical expenses and make health care more affordable.
Should We Pay Hospitals for Results or Volume?
- The fee-for-service model floods the health care system with high-cost care, fragmented experiences and outcomes that don’t always match the price tag.
- Instead of paying higher prices for greater volume, we need to align how hospitals are paid with the outcomes they deliver.
- Moving hospitals into value-based payment models means evolving toward a system that pays for what works and rewards providers for keeping people healthy.
