Blue Cross and Blue Shield of North Carolina (Blue Cross NC) posted a communication on September 13, 2023, advising providers of three drug billing errors that would help us identify overpaid or underpaid claims. In addition, Blue Cross NC is integrating clinical data aimed at reducing total costs and waste while improving overall Medicare patient outcomes through HighTouchRx (HTRx) prescriber outreach program. This will allow us to identify and target member-level drug optimization and cost-savings opportunities for pharmacy and medical benefit drugs.

A dedicated Clinical Pharmacist from Blue Cross NC is responsible for this program and all prescriber outreach. Our contracting providers may receive phone calls or faxes from our HTRx pharmacist who will discuss the opportunity and clinical recommendation with the prescriber or their staff. We strongly encourage providers to consider the recommendations, as they may result in increased patient safety, reduced financial burden to the member or significant total cost reductions overall.

The HTRx program has already identified significant savings for our Medicare members and providers. For example, we have identified cases where switching a member from tablets to capsules of the same drug and strength would result in more than $70,000 annual savings for the healthcare system. Additional examples of outreach may include duplicate therapy, therapy optimization to reduce pill burden, or switching members to lower-cost generic products.

For any questions, please contact Customer Service at 800-214-4844.