Summer 2009
Change in Rx benefit encourages generic use
Beginning in August 2009, the benefits of existing Individual Under-65 BlueChoice and BlueOptions products are being modified with the introduction of the new generic pharmacy benefit for members with MediScript (BlueChoice plans) and BlueScript (BlueOptions plans). The benefit change does not apply to Temporary Protection Insurance products.
The pharmacy benefit changes promote the use of lower-cost generic equivalent drugs in place of higher-cost brand medications. When filling prescriptions, members are encouraged to ask their pharmacist if a generic equivalent is available for their brand-name prescriptions.
Members of these health plans may experience a different pharmacy cost share when choosing brand medications. If a member chooses to fill a brand name prescription when a generic equivalent is available, the member’s cost share will include any copay, deductible and/or coinsurance, plus the difference between the generic and brand medication cost. The member’s cost will not exceed the price of the drug.
Example: |
| | Member Cost for Brand-Name Drug* | |
Brand-name drug cost: | $120 | 10% coinsurance for brand-name drug: | $12 |
Generic drug cost: | - $20 | + Difference in cost of brand vs. generic: | $100 |
Difference in cost: | $100 | Total cost to the member: | $112 |
* This is an example only and presumes any applicable deductible has been met. |
To confirm member pharmacy benefits, submit an Eligibility and Benefits transaction through the Availity®1 Health Information Network. Offices equipped with a card reader compatible with Availity’s card-processing program, CareRead®, can simply swipe the member’s ID card to access real-time benefit information.
Additional enhancements are planned for later this year.
1 Availity, L.L.C., is a multi-payer, joint-venture company. For more information or to register, visit Availity's website at www.availity.com. |
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Date Last Reviewed:
5/26/2009
Date Last Modified:
5/26/2009