Pharmacy Initiatives Designed to Help Save Money

In 1994, the average cost of a prescription was $28.67; today this cost has tripled and the cost is $68.261. Prescription drug affordability continues to be a focus at Blue Cross Blue Shield of Michigan and is one of the major reasons why they are enhancing their prescription drug plans in 2007 with new pharmacy initiatives.

The goal of these new initiatives is to help members and physicians learn about the wide range of prescription drug alternatives that can help members save on out-of-pocket costs. According to Kevin Seitz, executive vice president of Health Care Value Enhancement for BCBSM, “The Blues are moving in a direction that shows we have prescription benefits that meet our customers’ needs without sacrificing their quality of care.”

Most of the new initiatives are aimed at working with members and their physicians to make them aware of less-expensive generic equivalents or alternatives for the medications they are taking.

Here’s a look at these initiatives:

Generic Copay Waiver — Waives a one-time copay if a member switches from a brand-name drug to a generic equivalent, generic alternative or preferred brand drug
Member Education Therapeutic Interchange – Encourages members to switch to less-expensive generic drugs or over-the-counter equivalents of expensive brand-name drugs
Dose Optimization – Encourages physicians to prescribe a dosing regimen of once per day, instead of smaller doses throughout the day, for selected medications when appropriate
Brand to Alternate Generic Interchange — Encourages physicians to prescribe less-costly generic alternatives to expensive brand-name drugs
Brand to Brand Therapeutic Interchange — Encourages physicians to prescribe lower-cost branded drugs equal in strength and efficiency to targeted high-cost drugs
Quantity Limits for Selected Drugs — Aligns the dispensing of targeted drugs in quantities consistent with FDA-approved labeling or published clinical criteria for the drugs
Exclusion of Off-Label Coverage — Requires evidence of medical necessity when drugs are prescribed for uses other than those approved by the FDA (for example, growth hormones for anti-aging purposes)
Enhanced Polypharmacy Outreach and High-Utilization Management — Alerts physicians to potentially harmful situations that can occur if someone is being treated for multiple conditions or being treated by multiple physicians

The main emphasis of these initiatives is help members and physicians understand alternatives to higher-cost brand-name drugs. “These initiatives are a key way to address prescription drug costs,” said Atheer Kaddis, director of Clinical Pharmacy Services for BCBSM. “You have a drug that is equal in effectiveness, yet the price is less than 25 percent of the cost of the brand-name drug. That’s immediate cost savings to our members while maintaining their quality of care.”

Depending on the prescription drugs you are taking, BCBSM may contact you or your physician in the coming months to discuss alternative treatment considerations.

Visit www.bcbsm.com for more information on BCBSM’s prescription drug plans.

** Prescription Drug Trends, Kaiser Family Foundation, May 2007

What’s new at Blue Care Network

Care while traveling is easier than ever

By Kevin Klobucar

BCN Vice President and Regional Executive

A current series of credit card ads features quaint and obscure places that accept this particular brand of credit card. Although it may be terrific that some out-of-the-way boutique will let you run up a tab, it’s crucial that out-of-the-way hospitals, doctors and pharmacies take you health plan ID card.

With BCN you get the Blue Cross and Blue Shield – symbols recognized and accepted across the country. Because BCN is a Blue Cross and Blue Shield health plan, it’s the only HMO in Michigan that can offer its members comprehensive care when they travel. We do it through BlueCard, a program that gives our traveling members access to hospitals and doctors that participate with Blue plans across the country.

Within Michigan, we’ve opened our physician network so members living away from home – say, a student at college – can select any doctor who contracts with us, no matter where the member lives and where the doctor is located. Members simply select a primary care physician at their temporary residence.

Our Blue affiliation and our hard-to-beat travel coverage are two reasons BCN is a great choice for you and your employees.

For more information about Blue Care Network, contact the Ann Arbor Area Chamber of Commerce 734.665.4433 or email Jennifer Coleman. 

Blue Care Network of Michigan Reduces Copayments for Some Prescription Drugs

For its members who use certain prescription drugs, Blue Care Network of Michigan is making keeping healthy more affordable by reducing drug copayments for its HMO products. BCN is the HMO subsidiary of Blue Cross Blue Shield of Michigan.

"By reducing copayments, we’re not only saving our individual members and group customers money, we also are helping keep BCN members healthier by making it easier for them financially to maintain a proper drug regimen," said Marc Keshishian, M.D., BCN vice president and medical director of clinical affairs. It’s another way we’re increasing the value of the Blue card our members carry."

Beginning in March, BCN members who take Lipitor^® or Zocor^® to lower their cholesterol can — with a doctor’s consent — receive tablets that contain twice the normal dose of their medication, allowing them to take a half tablet instead of a whole one. A 30-day supply of the drug therefore will last 60 days, but the member will pay one copay rather than two, resulting in 50 percent savings for the member. BCN mailed free pill splitters to members taking Lipitor or Zocor in early March. Members who in the future are given drug prescriptions for Lipitor or Zocor also can obtain a doctor’s prescription for a pill splitter to be provided by their pharmacy.

Starting in mid-April, BCN members who take maintenance drugs for chronic conditions will be able to purchase a 90-day supply at most retail pharmacies and pay only two copays instead of three. Previously, this was possible only if members ordered their medications through BCN’s mail order vendor. The member’s doctor will determine which maintenance drugs are appropriate for a 90-day supply.

BCN also began this year a pilot program that lowers the copay for brand-name asthma control medications to the level of a generic drug copay. For example, a member whose copay is $40 for a formulary brand-name drug and $10 for a generic would pay $10 for the brand-name drug, a yearly savings of $360.

Seven brand-name drugs are covered: Asmanex^®, Azmacort^®, Flovent^®, Intal^®, Pulmicort^®, QVAR^® and Tilade^®. These drugs are commonly referred to as anti-inflammatory medications, and are the ones used to prevent future asthma attacks as opposed to medications used for quick relief. It’s hoped that by lowering the copays for these brand-name drugs to a generic level, more people will refill their prescriptions.

"The savings from these programs could be significant for both our individual members and group customers,” Keshishian said. “For example, if only 25 percent of our members who use Lipitor or Zocor take part in the half-tablet program, the estimated annual savings is $1 million."

The three drug initiatives pertain only to BCN’s commercial lines of business. BCN’s Medicare program — BCN Advantage — is not affected.

Blue Care Network of Michigan has more than 450,000 members, award-winning disease management programs and the largest HMOnetwork of physicians and hospitals in the state, with more than 3,200 primary care physicians, 9,300 specialists and 110 hospitals. Blue Care Network is the HMOaffiliate of Blue Cross Blue Shield of Michigan and an independent licensee of the Blue Cross and Blue Shield Association.