The Pharmacy Solutions Helping Blue Cross Rewrite the Prescription for Affordability

12.30.2025 | 3 min read

Key Takeaways

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.

In 2024, rising prescription drug prices drove a 15% increase in pharmacy spending for Blue Cross, reflecting the growing pressure unregulated drug prices place on the health care system. In response, Blue Cross implemented targeted pharmacy solutions that successfully held pharmacy spending flat in 2025, helping protect affordability for members and employers.

In an interview with Crain’s Grand Rapids Business, Atheer Kaddis, Vice President and Chief Pharmacy Officer of Pharmacy Services at Blue Cross, outlined the forces behind escalating drug costs and the solutions Blue Cross is implementing to counter them. Unregulated pricing, delayed competition and limited negotiating power have driven costs higher across the system—costs that ultimately fall on patients.

“Anyone on any of these medications has to pay part of that cost,” Kaddis said, emphasizing the importance of competition and purchasing strategies that put downward pressure on prices.

While upcoming federal price negotiations for certain Medicare drugs in 2026 and 2027 are a step forward, commercial plans still face significant gaps. Blue Cross is working now to close those gaps through targeted pharmacy solutions.

Turning Strategy into Savings

In 2025, Blue Cross focused on challenging long-standing pricing dynamics, especially as manufacturers delayed lower-cost generics and biosimilars. Two key initiatives delivered meaningful savings for members and employers.

First, Blue Cross expanded a focused biosimilar program for high-cost specialty drugs such as Humira and Stelara. By shifting utilization to biosimilars, Blue Cross reduced monthly drug costs from roughly $10,400 to under $1,000, saving members more than 90% off list prices.

“We shifted 99% of our utilizers to biosimilars and maintained that through the year,” Kaddis said. “Our pharmacy cost trends went down to almost zero.”

Second, Blue Cross partnered with Evio Pharmacy Solutions, a direct-purchasing model that bypasses traditional pharmacy benefit managers and wholesalers. By contracting directly with manufacturers and limiting dispensing to two pharmacies, Blue Cross secured dramatically lower prices on prescription and specialty medications.

“It’s allowed us to bring prices down to less than 10% of the cost of the branding,” Kaddis said. “That’s a discount of over 90%.”

Building Affordability for the Future

Looking ahead, Blue Cross will introduce an exclusive specialty pharmacy program in 2026 for large-group fully insured plans, further improving pricing on some of the most expensive drugs in the market. Managing today’s costs is essential to ensuring access to future breakthrough therapies—some of which may cost millions per dose.

“We have to manage therapies now so that when we do need to spend $2 or $3 million, we can afford it,” Kaddis said.

By rethinking how drugs are purchased, priced and dispensed, Blue Cross is leading the way toward a more affordable and sustainable pharmacy system—one that puts members first.