It wasn’t so long ago when being a pharmacist or pharmacy technician at a health insurance company was a bit of a lonely proposition. But the health care needs of the population change over time and insurers evolve to stay ahead of the trends.  

In 2013, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) employed four pharmacists. A dozen years later, our staff includes more than 80 pharmacists and another 70 pharmacy technicians spanning the entire enterprise: Population Health, Data and Analytics, Human Resources, and other divisions. 

Managing the quality and cost of care requires a comprehensive and coordinated approach, particularly when it comes to prescription drugs. Traditionally, these medications have been among the most significant cost drivers for Blue Cross NC members. But in 2024, we saw medical drugs drop to 10th on the list of largest cost drivers. 

Corporate pharmacists have played an important role in this success.  

Simply put, you can’t manage drug spending if you don’t understand drugs’ appropriate place in therapy. The education and training of pharmacists and pharmacy technicians is considerably more comprehensive than understanding what medicines chemically do in the body. Pharmacists understand what is occurring in the body in a disease state, what’s causing the condition, how that condition impacts quality of life, and how it can create barriers to optimal health. 

That very detailed, expansive knowledge of disease and therapeutics is extremely helpful in ensuring access to drugs on the health plan side. To make effective decisions, pharmacists pull in knowledge beyond what the drug is doing in the body at that moment.

Corporate pharmacists look at more than simply the dosage and schedule for a medicine. Pharmacist and pharmacy technician knowledge and input is also highly important to benefit design, copay, where to get medications, who can appropriately prescribe medications, and more. 

Corporate pharmacists aren’t filling prescriptions all day long, but their role is critical to making sure our members get the medicines they need at prices that are affordable: 

• Assessing the safety of new drugs
• Finding new ways to manage chronic conditions
• Combing through data to identify potential drug reactions or inappropriate uses
• Flagging potential cases of fraud and waste
• Maintaining a formulary of effective, affordable medications that are covered by insurance
• Collaborating with prescribers and employers to promote better member adherence to prescription guidelines
• Working directly with community pharmacists and other health care providers to improve quality and cost of care for our members

From managing authorizations to developing criteria for safe and effective medication use to helping members and providers with medication adherence to developing innovative initiatives increasing access and reducing cost of care, our pharmacists are integral to Blue Cross NC’s service to our members.

We invest in the pharmacy workforce pipeline, maintaining a healthy relationship with the Academy of Managed Care Pharmacy (AMCP) and the American Society of Health-System Pharmacists (ASHP). These prestigious professional organizations invite Blue Cross NC’s pharmacy residents to present research findings at their annual conferences. Our pharmacist intern program recently hosted one student from AMCP, one Corporate Pharmacy intern, nine Advanced Pharmacy Practice Experience students, four students from Campbell University College of Pharmacy & Health Sciences, and four students from Wingate University School of Pharmacy.  

At least 15 of our pharmacists on staff serve as preceptors of Advanced Pharmacy Practice Experiences for North Carolina-based schools of pharmacy. We also have three pharmacists on staff who co-instruct the Health Policy / Managed Care elective course at UNC Eshelman School of Pharmacy. Those same pharmacists oversee and administer a “Managed Care Pharmacy 101”-type elective at Campbell University. 

These pharmacy school classes are an important connection point between Blue Cross NC and the emerging pharmacy workforce. Sophia, now a third-year pharmacy student, attended a class lecture by one of our company’s pharmacists and was introduced to the world of managed care: “It’s a more unique field, so I wasn’t really aware of it. Having a public health background, you’re trying to make health care better, but at the same time, you’re trying to help manage these cost increases that are super sky high.” 

Intrigued, she inquired about internship opportunities at Blue Cross NC and ultimately joined the company as a managed care pharmacy intern on her way to a Doctor of Pharmacy and Master of Science and Public Health dual degree. 

Our corporate pharmacists are essential to helping our members get the medicines they need at prices they can afford. As their roles continue to evolve, we will see more impressive returns on our investment in the future of corporate pharmacy.