MiBlueDaily
Dec. 30, 2025
In 2024, rising prescription drug prices drove a 15% increase in pharmacy spending for Blue Cross, reflecting the growing pressure unregulated drug prices place on the health care system. In response, Blue Cross implemented targeted pharmacy solutions that successfully held pharmacy spending flat in 2025, helping protect affordability for members and employers.
In an interview with Crain’s Grand Rapids Business, Atheer Kaddis, Vice President and Chief Pharmacy Officer of Pharmacy Services at Blue Cross, outlined the forces behind escalating drug costs and the solutions Blue Cross is implementing to counter them. Unregulated pricing, delayed competition and limited negotiating power have driven costs higher across the system—costs that ultimately fall on patients.
“Anyone on any of these medications has to pay part of that cost,” Kaddis said, emphasizing the importance of competition and purchasing strategies that put downward pressure on prices.
While upcoming federal price negotiations for certain Medicare drugs in 2026 and 2027 are a step forward, commercial plans still face significant gaps. Blue Cross is working now to close those gaps through targeted pharmacy solutions.
Turning Strategy into Savings
In 2025, Blue Cross focused on challenging long-standing pricing dynamics, especially as manufacturers delayed lower-cost generics and biosimilars. Two key initiatives delivered meaningful savings for members and employers.
First, Blue Cross expanded a focused biosimilar program for high-cost specialty drugs such as Humira and Stelara. By shifting utilization to biosimilars, Blue Cross reduced monthly drug costs from roughly $10,400 to under $1,000, saving members more than 90% off list prices.
“We shifted 99% of our utilizers to biosimilars and maintained that through the year,” Kaddis said. “Our pharmacy cost trends went down to almost zero.”
Second, Blue Cross partnered with Evio Pharmacy Solutions, a direct-purchasing model that bypasses traditional pharmacy benefit managers and wholesalers. By contracting directly with manufacturers and limiting dispensing to two pharmacies, Blue Cross secured dramatically lower prices on prescription and specialty medications.
“It’s allowed us to bring prices down to less than 10% of the cost of the branding,” Kaddis said. “That’s a discount of over 90%.”