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Pharmacy Management

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Prescription Drug Plan
We look at our members holistically and offer coordinated benefits to help close gaps in care and improve overall heath. We combine our medical, pharmacy and lab data – but we go beyond the data to help ensure coordination of our people, programs and knowledge.  
With our drug lists and our gaps-in-care messaging, we improve member health. When we develop our drug lists, we see how drugs work in real life for our members. We use our medical and pharmacy data and analyze claims to make sure the medications really work.  
But that’s just the beginning.  
Improving the health of our members
We encourage medications that improve member health, and we see how drugs work in real life for our members, helping them make good health care choices. 
Reducing total health care costs
Cost-of-care and clinical programs focus on total costs, and we encourage medications that help to reduce those total costs. Both medical and pharmacy costs are our responsibility.  
Ensuring coordination of care
Medical and pharmacy strategies complement each other; they’re based on the same goals. Policies are aligned. We engage members and their doctors.  
Simplifying the member experience
Our medical and pharmacy experts work collaboratively. Members have one vendor, one contact, one ID card, and one website. Clients have one vendor, one contact, one contract, one eligibility feed, and one invoice.  
 
Member and Physician Education Strategy
We drive compliance to improve health and reduce costs. Gaps-in-care messaging for our clinical and cost-of-care programs is included in one communication. Members don’t receive multiple letters focused on individual clinical and cost-of-care programs. And to help ensure coordination of care and compliance, physicians also receive a consolidated communication with similar messages. By using targeted, concise communication, we help members make good health care choices and improve health outcomes.  
Medication Review
Once we identify a gap in care, the member receives a personalized Medication Review, which contains pharmacy messaging for our clinical and cost-of-care programs in one consolidated, health plan-branded, monthly member communication. 
MyHealth Note
When clients have both our medical and pharmacy benefits; we can access members’ combined medical, pharmacy and lab data, plus member eligibility and benefit information, in order to create a holistic picture. This allows us to send generic and therapeutic equivalent messages with member-specific cost savings.  
Patient Highlights
We send Patient Highlights, a consolidated communication, monthly to provide an overview of gaps in care for all of a physician’s patients. This approach eliminates the need to send multiple letters to physicians for each of their patients.  
 
Drug List Management
Drug Lists
We are leading the health care industry in the way we choose covered drugs, analyzing the strongest clinical drug studies – and, we use our member data, including pharmacy, medical and lab data, to see how drugs are really working for our members. We believe the right drugs to cover are the ones that do the best job for members, and reduce the total cost of care. Review our drug lists
Pharmacy & Therapeutics Process
A group of doctors and pharmacists – who are not our employees – lead the selection of drugs for our drug lists. This group performs regular clinical reviews, rates drugs based on how they work in real life, evaluates drug costs to make sure they are affordable, and chooses drugs that are safe, work well and offer the best value.  
Therapeutic Equivalents
We look at claims data to find opportunities for our members to save money by switching them to lower-cost, therapeutically equivalent drugs. We send members personalized messages about medications that may reduce their costs – and include specific cost savings.  
Preferred Glucometer Program
We encourage members with diabetes to use preferred blood glucose meters, which may help them save money on test strips. Through this voluntary program, members are offered a complimentary meter.  
Generic Drug Strategy
We take a comprehensive approach to encourage generics and help keep our members healthy and reduce costs.  
What if a drug is not on the medication list?
Our medication lists allows members and their doctor to choose from a wide variety of prescription drugs. Members should talk with their doctor about prescribing a drug that is on the medication list. If a drug is selected that is not on the medication list, the member will be responsible for the full cost of the drug. Members can talk to their doctor about making a request to Express Scripts for an exception review of a drug not on the medication list.  
 
More resources that may help you
Pharmacy FAQs
Click here to initiate an Electronic Prior Authorization Request
 
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Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., and/or HealthPlus, LLC., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State. All external sites will open in a new browser window. Please view our Website Privacy Policy for more information.