How our prescription partnership saves money

The rise of prescription drug costs has been a major concern for decades now. Sometimes patients don’t take their medications as often as necessary to treat or prevent a condition. And studies show that cost is among the most common reasons for medication non-adherence.

This is especially concerning for employers. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has been working to address these costs on multiple fronts, including the launch of our collaboration with Sempre Health in 2022.

As prescription drug prices have risen, patients’ adherence to prescribed medications has declined. Blue Cross NC and Sempre Health want to reverse both trends with a text-message-based program that allows eligible members to save money on prescriptions when they refill their medications on time.

The best part is, this doesn’t cost our members or our employer clients anything. If you’re thinking, “I know there’s a catch. There’s always a catch,” you may be disappointed to learn that there isn’t a catch.

Our collaboration with Sempre is generating raves from our members:

• “It has provided me with life-saving medication that I would not be able to afford otherwise.”
• “This has helped my family out financially, especially with other medical costs we have. Most importantly, it has helped me improve my A1C and weight.”
• “I must say this program saved my life. I went weeks without insulin until I was signed up in your program. Now I feel safe and secure.”
• “Thank you for this remarkable program and the impact it has made for me and my family.”

How it works

The program incentivizes patients managing chronic conditions like diabetic, respiratory, and cardiovascular problems to stay on track with their treatments and helps drive down health care costs for everyone.

Since its launch, Sempre Health has reinstated more than 1,600 patients back into their treatment programs and helped more than 17,000 Blue Cross NC members save over $4.2 million on their prescription cost-shares – that’s an average of nearly $95 per participating member per refill.

• Members don’t need an account or an app to take advantage of drug discounts.
• Sempre Health identifies members taking preferred, single-source medications for chronic conditions that do not have generic or less expensive options.
• Eligible members receive invitations to enroll via direct mail – and enrollment takes less than five seconds.
• Once enrolled, members automatically begin receiving prescription discounts at the pharmacy counter.
• Each month, members receive text reminders when it’s time to refill and the savings incentive increases every month they refill on time. It’s simple: If you refill on time, you pay less for your medicine.

Members qualify by having at least one paid or reversed claim of one of the program medications in the last 12 months.

The cost of non-adherence

Failure to adhere to prescriptions is a significant cost-driver – not just for individuals but for everyone across the health care system.

Research published by the Mayo Clinic shows that as many as 50% of patients who are prescribed medications for chronic conditions like diabetes and hypertension don’t take those drugs as prescribed by their doctors, contributing to at least 125,000 preventable deaths – and $300 billion in unnecessary costs – each year.

Employers already know how big a problem non-adherence is. In a survey by the National Pharmaceutical Council, nearly 90% of employers named medication compliance as a top health management objective for their companies.

As we continue to work with pharmaceutical companies and pharmacists to lower the cost of prescription drugs, we must also help our members take a more active role in their own health, including using medications as prescribed.