Prescription Drugs

	Prescription plan features
	Prescription coverage
	Example of generic drug savings
	Top 10 prescriptions for employees and retirees

Through your careful use of prescriptions, release of new generic drugs, and plan changes, drug spending in the city’s HMO and PPO has flattened. Your use of generic alternatives and other cost conscientious choices have really paid off, so the prescription benefits will stay the same for this plan year.

But that doesn’t mean you can stop here. The gameboard changes constantly, with prescription drug costs continuing to increase at a faster rate than other medical costs, introduction of new high-priced drugs, brand name patents expiring resulting in new generics, and unusual new uses for those pricey brand name drugs.

You’ve become better consumers of prescriptions – probably because you are asking the right questions:

• Is this medication required for my condition, or will it get better by itself?
• Is this the best medication for my condition?
• Is there a generic medication available?
• If I have to take medication for more than 30 days, is mail order less expensive?
• Will this medication interact badly with other medications I take?

The drug manufacturers want you to be charmed by their colorful advertisements, and ask your doctor for the newest high-cost drug. Of course! That’s the one that makes the most money for them. Don’t be charmed – Be smart! Ask these questions, and you can do your part to slow unnecessary drug cost increases. If your doctor prescribes medication, make sure you discuss it, and understand how it is supposed to work.

Prescription plan features

Here are the features of your prescription benefit that are keeping the plan affordable:

This is a three-tier prescription plan, with different copayments in each tier. Drugs are assigned to the tiers based on the BCBSTX formulary, which can change annually, usually in May. See the chart of prescription coverage.

To find out which drugs are in each of the three tiers, go to www.bcbstx.com. If the cost of the prescription is less than the copayment, you pay the lower amount.

The step therapy feature requires your doctor to consider alternative medication before prescribing the higher-cost medications in five prescription drug categories.

The five categories are below:

• COX-2 Inhibitors (Celebrex)
• Leukotrienes for Asthma (Accolate, Singulair)
• Rheumatoid arthritis drugs (Enbrel, Humira, Kineret)
• ACE Inhibitors (Accupril, Mavik, Altace, Aceon)
• Angiotensin II receptor blockers (Avapro, Atacand, Cozaar, Diovan)

New drugs could be added periodically.

Certain drugs are limited to a specific quantity over 30 or 90 days. This is called quantity versus time and applies to retail and mail order prescriptions, including all nasal inhalers, migraine medications, asthma inhalers, pain management medicines, proton pump inhibitors, and others. When more medication is necessary, BCBSTX must approve the higher quantity. To find out what drugs are subject to quantity limits, visit www.bcbstx.com or call 800-521-2227.

Through BCBSTX’s mail order pharmacy, Prime Therapeutics, you can order a 90-day supply for the price of a 60-day supply.

		Mail-order sounds easy sign me up! To switch your long-term perscriptions to Prime Therapeutics, visit www.houstontx.gov/oe08.mail.htm or get a mail order form from your human resources liaison.

The mandatory generic feature calls for filling your prescription with a generic drug if one is available. Remember, generic drugs are copies of brand-name drugs, identical in dosage, safety, strength, quality, performance and intended use. If you still prefer the brand-name drug when a generic is available, you will have to pay extra. See the Prescription Coverage chart, which illustrates the savings.

		Mandatory generic If your doctor prescribes a generic drug but you purchase a brand prescription, you will pay more for your medicine. Your copayment will be the total of the generic copayment plus the difference between the cost of the brand and the generic drug. Doctor prescribes generic Fluoxetine (20 mg) $16.39 You purchase brand-name Prozac (20 mg) $174.99 Difference in price $158.60 Your cost = price difference + $10 generic copayment $168.60

Prescription Coverage

The HMO and PPO plans provide access to prescriptions through copayments –always lower than paying the old-fashioned 20% coinsurance. That’s because we want you to take the medications you need to get well, or manage your condition.

To find a participating pharmacy, go to www.bcbstx.comand use the pharmacy or provider finder option.

Top 10 prescriptions for employees and retirees

Paying the retail cost for prescription drugs is expensive. But you are spared that expense by the city’s three-tier prescription drug benefit – especially if you use generic drugs.

It’s easy to find what tier your prescriptions are in. Check the chart below to see if your prescription is also one of the top 10 medicines. Then, compare your cost with the retail cost and see how much your plan saves you in out-of-pocket expenses. To see the entire list of preferred drugs, go to www.bcbstx.com, pharmacy option.

*Step therapy drug.

As always, if the retail cost of the prescription is less than the copayment, you pay the lower amount.

As of October 2007