PROVIDENCE – With its new formulary for prescription drugs, which went into effect Nov. 1, Blue Cross & Blue Shield of Rhode Island has reduced the number of options that will be covered for a number of brand-name drug prescriptions, including those used in the treatment of allergies, such as Allegra.
The changes reflect the health insurance firm’s long-term strategy to increase use of generic drugs by its membership with the goal of moderating long-term premium increases, according to Dr. Gus Manocchia, vice president and chief medical officer at BCBSRI.
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More than 14.7 million prescriptions were filled at retail pharmacies in Rhode Island in 2009, at a total cost of about $847 million, according to the Kaiser Family Foundation. On average, that is about 14 prescriptions per person, higher than the national average of 12.1 per person.
Prescription drug costs account for about 20 percent of its health insurance claims from its 600,000 members, according to Manocchia. “That’s a big piece of the health care pie,” he said.
Towards that end, BCBSRI has become an advocate of generic drug prescriptions, says Tara Higgins, a clinical pharmacist at BCBSRI, with the goal of reducing the cost and limiting the annual increase on pharmaceuticals, with a minimal impact on quality.
“In all the categories [of reduced coverage], there are either generics or over-the-counter alternatives that are used to treat the same conditions,” Higgins said. “The big difference is in price.”
The Nov. 1 changes affected fewer than 30,000 of Blue Cross members, and of those, only 16,000 were “impacted” by the drug exclusions, according to Kimberly R. Reingold, BCBSRI spokeswoman. The formulary is conducted twice a year, she said.
The cost savings in the use of generics can be dramatic, according to Manocchia. The prescription for an equivalent generic drug for the popular acid reflux medication, Nexium, for instance, costs $25, compared with $200 from the brand-name drug, Manocchia said.
In the next two years, a number of popular prescription drugs will become open to generic competition – Lexapro, for treatment of depression, Singulair, for treatment of allergies and asthma, and Actos, for treatment of diabetes, according to Higgins. This will increase the use of generic drugs, and further drive down the overall costs of health insurance claims.
Those savings will be indirectly passed onto consumers, Manocchia said, in the ability of Blue Cross to lower the cost of what it pays for prescription benefits. “Most employers are supportive of anything we can do to lower the cost of health insurance while maintaining the quality of care,” he said. “By controlling pharmacy costs, we’re trying to address the overall issue of affordability.”
One ongoing program is the use of medication dispensers that provide members 30 days worth of generic drug samples. First introduced as a pilot program in 2005, the program is a partnership with MedVantx Generic Drug Delivery Network of San Diego.
Today, MedVantx dispensers are being used by 213 providers in 35 practices across Rhode Island, including 20 patient-centered medical homes, according to Kimberly R. Reingold, BCBSRI spokeswoman. Annually, about 15,000 samples are dispensed.
