Managing Inflammatory Bowel Disease With Care That Connects

Inflammatory Bowel Disease (IBD), including Crohn’s disease and ulcerative colitis, affects millions of adults in the United States. These lifelong conditions often require ongoing treatment with specialty and biologic medications. For employers and employees alike, IBD can bring physical, emotional, and financial challenges.

At Excellus BlueCross BlueShield, we believe better care starts with connection. By bringing pharmacy and medical benefits together, we help members manage IBD more confidently while helping employers better manage the cost of care.

A More Coordinated Approach to IBD Care

IBD affects more than the digestive system—it can disrupt daily routines, work life, and overall wellbeing. That’s why we take a whole-person approach. When pharmacy and medical care work together, members experience fewer gaps in care and more consistent support.

This integrated approach also supports preventive care. When appropriate, members with an Excellus BCBS plan may have access to options like Cologuard®, an at-home colorectal cancer screening test that can be completed without an in-office procedure. Preventive screenings like this can help detect concerns earlier and reduce the need for more invasive care later.

Recent industry studies show that rising colonoscopy costs and shifting utilization patterns continue to drive up overall healthcare spending, with national reviews estimating tens of millions in avoidable costs each year. Non-invasive screening options, such as Cologuard®, have already demonstrated measurable savings—about $9 million in 2024 alone—with further growth expected. For employers offering plans through Excellus BCBS, promoting the use of these screenings is a simple way to support early detection, improve member health, and manage long-term costs.

Supporting Employers While Putting Members First

Our pharmacy and medical strategies are designed to support people living with IBD while helping employers manage rising specialty drug costs.

Our approach includes:

1. Condition-Specific Formulary Management
   We use an indication-based formulary so preferred medications align with specific inflammatory conditions and evidence-based care.
   
2. Prior Authorization and Clinical Review
   Most inflammatory specialty medications require prior authorization. This helps confirm diagnosis and ensures treatment follows standard clinical guidelines.
   
3. Specialty Drug Benefit Optimization
   When medications may be covered under either the medical or pharmacy benefit, our policies guide use to the most cost-effective option when appropriate.
   
4. Site of Care* Programs
   For certain infused therapies, including Entyvio, Inflectra, Remicade, and Simponi Aria, eligible members receiving care at high-cost facilities may have the option to receive treatment in lower-cost settings, including home infusion. This can improve convenience while lowering costs.
   
5. SaveOnSP® Pharmacy Specialty Copay Assistance*
   Helps reduce specialty medication out-of-pocket costs for employers and employees.
   
6. HelpScript® Medical Specialty Copay Assistance*
   Provides financial support for eligible specialty medications covered under the medical benefit.
   
7. Biosimilar Optimization
   Excellus BCBS supports the use of biosimilars to improve access, affordability, and medication adherence. Biosimilars are included across all eligible drug categories, including alternatives to Actemra, Remicade and Humira. 
   
8. SafeGuardRx® Programs
   Offers additional savings opportunities through manufacturer credits and targeted programs for high-cost therapies.

Care Built Around the Individual

No two people experience IBD the same way. Our integrated model allows care teams to look at the full picture—medical needs, lifestyle factors, and ongoing support—to help members manage their condition day to day.

ThriveWell℠, Powered by Personify Health*

ThriveWell is Excellus BCBS’s digital wellbeing platform designed to help employees make small, meaningful changes to their health. Through our partnership with Personify Health, members can focus on the areas of wellbeing that matter most to them.

Members also have access to FoodSmart, a digital nutrition platform that makes healthy eating easier by helping members:

• Understand their eating habits and receive personalized tips
• Find recipes based on dietary needs, preferences, time, and budget
• Create grocery lists and plan meals with confidence

Care and Support for Members with Ongoing Conditions

High-Cost Claimant Team
A small percentage of members often account for a large share of health care costs. Our High Cost Claimant Team provides focused support for members with complex or chronic conditions, helping improve outcomes and reduce avoidable costs. In 2024 alone, pharmacy interventions through this program resulted in more than $513,000 in medication cost savings and cost avoidance².

Care Management Team
Through proactive outreach, data insights, and provider coordination, care managers help members stay on track with treatment, set health goals, and manage their overall wellbeing.

The entire team of Excellus BCBS’ clinicians—including nurses, pharmacists, physicians, dietitians, social workers, and customer care representatives—work together to keep members at the center of care.

Registered dietitians support members by discussing nutrition and how food choices may affect IBD symptoms and related conditions.

Members may also receive support from Therapeutic Resource Center (TRC) pharmacists at Accredo who specialize in inflammatory conditions.

Tools That Help Members Stay Informed and Supported

HealthWise® Knowledgebase
Available through the member portal, this resource provides clear, easy-to-understand information on thousands of health topics, helping members make informed decisions.

Wellframe® Mobile App
Free to Excellus BCBS members, the Wellframe app puts support at their fingertips, including:

• Secure messaging with a care manager
• Personalized health plans
• Medication reminders
• Access to dietitians and educational resources

When Care Is Connected, Everybody Benefits

By bringing medical and pharmacy care together, Excellus BlueCross BlueShield helps employers support their teams and helps members living with IBD feel more supported, informed, and confident in their care.

Disclaimer
*Program eligibility may vary by funding arrangement. A shared savings fee or buy-up may also be associated with the program.
Copyright © 2026, Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. All rights reserved. 
1 2018-2024 data provided by Personify Health.    
2 Cost savings based on 2024 claims experience for members engaged in CM.   
3 Management Outcomes data based on 2024 experience for Commercial members engaged in CM/DM based on 2024 researched cost avoidance estimate of $1,500 (those with “Other” conditions).
4 2024 Health Plan Data.   
SaveOnSP is an independent company that offers specialty coinsurance assistance services for certain specialty prescription drugs to Excellus BlueCross BlueShield members. 
Excellus BlueCross BlueShield has contracted with Expion Health Company, an independent company, to provide HelpScript program benefits to our members. 
Personify Health is an independent company and offers a digital wellbeing service on behalf of Excellus BlueCross BlueShield. 
Healthwise is an independent company that provides condition and disease management education to Excellus BlueCross BlueShield members.  
Wellframe is an independent company that provides a health and wellness support mobile app to Excellus BCBS members.