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Blue Cross and Blue ShieldFeatured HBD Story December 26, 2007 Aetna, Blue Shield of California Roll
Out New Drug Benefit Programs That Reduce or Eliminate Copays to Improve
Compliance, Reward Use of Low-Cost Generics Reprinted from DRUG BENEFIT NEWS, biweekly news, data and business strategies for health plans, PBMs and pharmaceutical companies. Two large health plans are rolling out new drug benefit programs that reduce or eliminate copayments on certain medications as an incentive to use low-cost generic drugs and comply with therapies that can avoid more expensive medical complications later on. Blue Shield of California on Dec. 4 unveiled a new program that eliminates or reduces copays for generic drugs. The program is available to employer groups with 51 or more employees. The program offers generic copays of zero or $3 at retail network pharmacies. The new option will be available starting January, the company said. While members' out-of-pocket costs are reduced, overall costs of health care also can be controlled over time, bringing the prospect of further cost savings for employers, according to Blue Shield of California. "It gives members a strong incentive to ask their doctor to prescribe generic drugs, saving them money while maintaining their quality of care," Nancy Stalker, Pharm.D., California Blue Shield's vice president of pharmacy services, said in a prepared statement. In a similar move, Aetna, Inc. on Dec. 5 said it was launching "Aetna Healthy Actions Rx-Savings," an incentive program for self-funded plans that lets employers pay part or all of certain employees' copays. Eligible employees are those with high-risk clinical profiles, and those who take medications for specific chronic conditions, including asthma, diabetes, high cholesterol, high blood pressure and heart disease, Aetna said. The program is designed to encourage compliance with therapies shown to effectively manage conditions of high-risk members, Aetna said. Eligible members are identified through Aetna's ActiveHealth Management CareEngine System technology, which can identify at-risk individuals who use a drug covered in the program, as well as those who could benefit from use of a drug covered in the program. "Lower costs have been shown to help improve medication adherence, and we believe this will lead to improved care, and reduce costs," Ed Pezalla, M.D., national medical director of Aetna Pharmacy Management, said in a prepared statement. Jeff Taylor, pharmacy director at Aetna, tells DBN that Aetna hasn't yet generated information with regard to the financial benefits of the new program. "Our focus is on helping to improve the overall quality of care
for members with certain chronic health conditions," Taylor says.
"By lowering copays, we hope to encourage members to take their
medication as directed by their doctor, and better manage their condition,
which ultimately can result in better health outcomes and potentially
help reduce overall health care costs." |
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