BCBS Michigan Switches PBM From Express Scripts to OptumRx

Blue Cross Blue Shield of Michigan chose OptumRx as its new pharmacy benefit provider, ending a relationship with Express Scripts.  

The change will take effect on different days depending on membership type. On Jan. 1, 2022, Express Scripts will no longer be BCBS of Michigan’s pharmacy benefit provider for commercial individual and group members. The change will occur on Jan. 1, 2023, for Medicare individual and group members.

The new relationship with OptumRx will help BCBS of Michigan better manage drug spending and improve member engagement with pharmacy treatment. OptumRx will help BCBS of Michigan administer pharmacy claims, manage rebate contracting, provide mail prescriptions and manage Blue Cross’ pharmacy networks.

Blue Cross Blue Shield of Michigan had previously approved a plan to contract with Express Scripts for its retail commercial business in Michigan. The contract was effective Jan. 1, 2019.

The decision at the time to shift network management of 2,400 pharmacies from about eight in-house employees to Express Scripts was intended to reduce administrative costs and pharmacy prices.

Blue Cross Blue Shield of Michigan is a nonprofit mutual insurance company founded in 1939. The company is largest health insurer in Michigan, serving 4.5 million people here and 1.6 million more in other states. BCBSMI has the largest network of doctors and hospitals in Michigan: 152 hospitals, and more than 33,000 doctors. BCBSMI has more than 8,100 employees. 

Blue Care Network of Michigan, a subsidiary of Blue Cross of Michigan, is a nonprofit health maintenance organization with over 900,000 members. Its network includes almost 6,000 primary care physicians, over 23,000 specialists and most of the state’s leading hospitals. 

Takeaway: BCBS Michigan has approximately 2 million members who have pharmacy benefits in multiple product offerings