Capital Blue Cross Saves by Accessing Manufacturer Coupons


Capital Blue Cross uses algorithms to help find drug manufacturer coupon programs. It has saved $4.5 million in the first quarter of 2023.

A Capital Blue Cross program has saved companies and their employees about $4.5 million in the first quarter of 2023, or about $3,000 per person. Capital Blue Cross serves a 21-county region in Central Pennsylvania and the Lehigh Valley and is a licensee of Blue Cross Blue Shield Association.

The program, called FlexAccess, was implemented in January 2023 and uses proprietary algorithms that help optimize manufacturer coupon programs available in the market. The solution scans for drug manufacturer coupons for expensive medications – both for specialty and traditional drugs, including rheumatoid arthritis, psoriasis, and Crohn’s Disease, as well as HIV and transplant drugs.

FlexAccess was developed by Prime Therapeutics, a PBM that is owned by 19 Blue Cross and Blue Shield plans. Through this program, Capital Blue Cross is able to lower out-of-pocket costs for patients, and the plan applies any coupons toward deductibles. Drug discount programs, however, are not applied toward deductibles, according to the plan’s website.

Samir Mistry

Samir Mistry

“FlexAccess is a copay optimization program designed to lower expensive specialty and brand drug costs by assisting members and employer groups in taking full advantage of available coupon programs,” Samir Mistry, Capital Blue Cross vice president of pharmacy strategy and services, told Formulary Watch.

“Capital fully understands the challenges people face in paying for expensive medications, and knows that high prices are a primary reason people fail to take drugs as prescribed,” Mistry said. “We launched this program because helping our members lower their drug costs means there’s a better chance they’ll adhere to prescriptions that could literally save their lives. It was a clear way we could go the extra mile to put our members’ health first.”

Related: Capital Blue Cross Teams up with Mark Cuban’s Pharmacy

In addition to FlexAccess, Capital has other programs designed to help consumer costs for drugs. The insurer as partnered with Mark Cuban Cost Plus Drugs, allowing members to use their Capital ID cards at Cost Plus Drugs’ online pharmacy for prescriptions. Some Capital members taking advantage of the program are trimming up to 30% to 40% of their drug costs.

In addition, the insurer has a patient-assistance program called Capital Blue Cross RxAid that helps eligible members eliminate or reduce their share for certain high-cost specialty drugs such as those used to treat cancer or rare conditions such as hemophilia. For doctors, Capital Blue Cross has a tool that provides real-time information about available drug options and a member’s specific pharmacy benefit, allowing them to compare exact out-of-pocket drug costs before writing a prescription.

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