Spring 2009

New benefit change supports generic drug use

In April 2009, Blue Cross and Blue Shield of Florida (BCBSF) is introducing a new generic pharmacy benefit for members of some group health plans effective with their renewal dates. The benefit change encourages members to choose equivalent lower-cost generic drugs in place of higher-cost brand medications. Generic substitution is a common benefit for other health insurance carriers.

The benefit change will apply to the following pharmacy programs and group members:

• BlueScript (BlueOptions and BlueChoice plans)

• MediScript (BlueChoice plans)

• BlueCareRx (BlueCare HMO plans)

Members of these group health plans may experience a different cost share at the pharmacy when choosing brand medications. If a member chooses to fill a brand-name prescription when a generic equivalent is available, the member will be required to pay the brand cost share (i.e., deductible, copay and/or coinsurance) plus the difference between the generic and brand ingredient cost. The member’s cost will not exceed the cost of the drug.

Notification to existing members began in February. Because generic medications are usually less expensive, members are being encouraged to ask their doctors to prescribe generic drugs. Additionally, when filling prescriptions, members are encouraged to ask their pharmacists if a generic equivalent is available for their brand-name prescriptions. Generic substitution does not apply if a physician requests a brand medication, and the member is responsible for the higher copay.

To confirm member pharmacy benefits, submit an Eligibility and Benefits transaction through the Availity^®1 Health Information Network. If your office is equipped with a card reader compatible with Availity’s card processing program, CareRead^®, you can simply swipe the member’s ID card to access real-time benefits information.