by Dave Schafer

Even with benefits from the city, the six medications Karen Burton takes daily would cost nearly $2,500 per year at her local Walgreens. But the widow has found a way to ease those costs.

She uses a mail-order pharmacy.

Through the home-delivery service, Burton gets three months worth of drugs for the price of two months.

“It’s a lot cheaper,” said Burton, senior account clerk with the Aviation Department. “I don’t think anybody wants to throw their money away.”

Since July 2000, AdvancePCS has been the mail-order pharmacy for Blue Cross Blue Shield of Texas, the city’s health-care provider. That will soon change. On Jan. 1, Prime Therapeutics will become the pharmacy benefits manager for employees and retirees covered under the city’s plan.

Few changes
Except for the reclassification of some drugs from preferred to nonpreferred status, members shouldn’t notice any changes, said Stacy Sloan, strategic account executive with BCBSTX.

“We expect to have greater control over pharmacy costs and how we manage the pharmacy benefits for our customers,” Sloan said. “The processing and how it will appear to the member will be seamless. The only changes that the member will feel will be the formulary list.”

A formulary is the list of drugs BCBSTX prefers doctors prescribe. The city’s formulary breaks down into three categories: generic, preferred and nonpreferred. The categories have an ascending copay of $10, $30 and $45.

The city’s formulary list will change May 1, 2005. The 2005 preferred drug list will be available Jan. 1 on BCBSTX’s Web site, www.bcbstx.com, Sloan said.

Just three of the 25 prescription drugs most used by city employees and retirees are moving from preferred to nonpreferred: Pravachol, Wellbutrin and Oxycontin CR. All have generic versions available.

Actos, which improves blood-sugar control for people with type 2 diabetes, is also one of those 25 most-used drugs. It will move from nonpreferred to preferred, meaning it will have a lower copayment.

Sloan said safety, effectiveness, uniqueness of drug and overall cost are factors that determine which drugs are in the preferred list

HMO Blue Texas plan members will have access to the same pharmacies they have now. About 97 percent of PPO plan pharmacies will be covered, Sloan said.

Except for narcotics and compound drugs, which have to be mixed at the pharmacy, prescriptions with refills left won’t have to be rewritten by your doctor, Sloan said.

Members who expect to run out of medication before Jan.10, 2005, should mail their prescriptions to AdvancePCS before Dec. 24, Sloan said. Those who don’t need new medications until after Jan. 10 should mail their prescription to Prime around Dec. 24.

For new prescriptions written in mid- to late December, ask your doctor to give you a 30-day script to fill at the local pharmacy and an additional 90-day prescription to send to Prime.

Prime manages pharmacy benefits for Blue Cross Blue Shield chapters in six other states and will add two more, including Texas, in January. Because the medications are bought in bulk, the cost per pill will decrease, saving BCBSTX money.

Savings could be passed to the city and help offset the escalating cost of prescription drug benefits, which for the city increased 7.25 percent in FY 2003-2004.

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Karen Burton, Aviation, uses a mail-order pharmacy to get three months' worth of prescription for the price of two months. Photo by Dave Schafer

Follow the route your prescription order takes from Prime Theraputics to your home