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New pharmacy plan designs
can help your bottom line 01/22/07
In an effort to combat increasing prescription drug costs,
the Blues are introducing several new prescription drug plan
options with prepackaged cost control features. The pharmacy
management options are new for April 2007 and are designed
to help protect your company's bottom line, while still giving
members the same quality prescription drug coverage they've
come to expect from Michigan's most trusted name in health
care.
The
Blues Custom Formulary determines coverage under the
new drug plan options. The Custom Formulary is a continually
updated list of FDA-approved medications representing each
therapeutic class. Each drug on this list is carefully chosen
by BCBSM's Pharmacy and Therapeutics Committee and is included
because of its effectiveness, safety, uniqueness and cost
efficiency. The goal of our formulary is to provide the greatest
therapeutic value to members at the lowest possible cost.
The
new prescription drug plan options include several cost-management
features, such as prior authorization and step therapy, to
significantly reduce your pharmacy premiums by as much as
30 percent to 50 percent, depending on benefit design. The
options include either two-tier or triple-tier copays. The
two-tier plans are administered with a closed formulary. Under
a closed formulary, brand-name drugs not included in the Custom
Formulary (nonformulary brands) are not covered.
BCBSM's
triple-tier or two-tier plan options offer several levels
of copays, including flat dollar and percentage copays with
minimum and maximum copay amounts, with these built-in cost
management features:
- Prior
authorization –
A physician must obtain approval from BCBSM before prescribing
select prescription drugs to prevent alternative use or
misuse and to ensure that members receive the most appropriate
and cost-effective drug therapy.
- Step
therapy – Payment
is not approved for some drugs unless the member has tried
other medications before trying the step therapy drug. Members
can often be treated successfully with less expensive medications
that will not only save the plan money, but can also save
members money in lower copayments.
- Mandatory
maximum allowable cost –
If the prescribing physician writes "dispense as written"
or "DAW" on a prescription or if the member requests a brand-name
drug when a generic equivalent is available, the member
is responsible for the difference in cost between the brand
and the generic, in addition to the applicable copay.
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Mail order (home delivery) or 90-day supply via retail pharmacies
Members
can have both convenience and copay savings on drugs used
for chronic conditions if they choose to receive them via
home delivery or through our 90-day retail network of pharmacies.
Members may be able to receive up to a 90-day supply of
drugs for two times their standard 34-day retail copay.
- Exclusion
of physician-administered injectable drugs –
Injectable drugs administered by a health care professional
(not self-administered) are not covered under the pharmacy
benefit, but may be covered under the member's medical benefit.
For
more information about our pharmacy plan designs for 2007
or to purchase prescription drug coverage for your company,
contact your BCBSM sales representative or Blues-contracted
agent, or visit our Web site at bcbsm.com.
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