When Excellus BlueCross BlueShield launched its Pharmacy Concierge program, its priority was improving member care. Slowing growth in drug spending was an added benefit. Three years in, the health plan’s metrics show the Upstate, N.Y.-based health plan is meeting both objectives.
In 2024, the Excellus BCBS Pharmacy Concierge team eliminated $17 million in unnecessary or inappropriate pharmacy spending for its midsize and large employers. Nearly 2,000 employers participated, and more than 11 million claims were reviewed for potential clinical safety and/or savings opportunities. So far in 2025, the clinical pharmacists have identified nearly $3 million in unnecessary or inappropriate pharmacy costs.
“With Pharmacy Concierge, our team of clinical pharmacists reviews an employer group’s pharmacy claims for opportunities to improve patient care and/or reduce pharmacy spending,” says Mona Chitre, PharmD, Chief Pharmacy Officer and President of pharmacy solutions at Excellus BCBS. "This includes finding unnecessary or inappropriate medications, incorrect dosing, safety concerns, and savings opportunities with approved generics or biosimilars.”
The health plan cites several examples of both member care improvements and savings for its groups:
- A member had been prescribed two different medications that, when used at the same time, had no added benefit, according to American Diabetes Association guidelines. In addition, one of the medications is associated with potential safety concerns. Outreach was made to the prescribing physician, who worked with the member to adjust the therapy.
- A member was prescribed an incorrect dosage of an anti-depressant. The physician was notified of the dosing issue and a lower-cost generic alternative was also suggested. The member is now taking the correct and safer dosage, with an annual out-of-pocket savings of $3,500.
- A consortium of upstate New York school districts reduced pharmacy spending by more than $1 million last year using Pharmacy Concierge. Our program delivered similar results for this client the previous year, resulting in significant cumulative savings.
- Our outreach to mental health prescribers resulted in $3.8 million in savings. Excellus BCBS’ pharmacy team targeted treatments that can create an unnecessary cost-burden for members, recommending transition to more affordable alternatives that work just as well.
- Our work with ophthalmologists delivered over $760,000 in savings for our clients. This is accomplished through simplification, recommending streamlined medication regimens that enhance adherence and affordability.
- A member undergoing treatment for lymphoma in 2024 was prescribed a brand-name medication to treat their condition. Excellus BCBS Pharmacy Concierge partnered with the patient’s oncologist to get the member transitioned to the generic version, saving $68,000.
Chitre says all medication decisions are made by the member’s provider in consultation with their patient.
To learn more about Pharmacy Concierge, visit excellusforbusiness.com.
Contact:
Corporate.Communications@excellus.com
Excellus BlueCross BlueShield, an independent licensee of the Blue Cross Blue Shield Association, is a nonprofit health plan with about 1.5 million upstate New York members. The company's mission is to help people live healthier and more secure lives through access to high-quality, affordable health care. Its products and services include cost-saving prescription drug discounts, wellness tracking tools and access to telemedicine. With about 4,500 employees, the company is committed to attracting and retaining a diverse workforce to foster innovation and better serve its members. It also encourages employees to engage in their communities by providing paid volunteer time off as one of many benefits. To learn more, visit ExcellusBCBS.com.
