Blue Cross rolls out pharmacy initiatives

Beginning July 1, Blue Cross Blue Shield of Michigan began implementing a series of nine new pharmacy initiatives designed to strike a balance between quality of care and savings. The actions apply across the board to members with Blue Cross coverage and do not involve any changes in policy coverage or premium rates.

The new program is Blue Cross’s response to industry-wide efforts to manage pharmacy costs—the primary reason for soaring medical costs in the U.S.—while maintaining high-quality care. Most initiatives involve working with physicians and pharmacists to minimize member disruption and address such important issues as appropriate use, overuse and prescribing regimens of prescription medications.

For example, the Dose Optimization initiative will encourage physicians to change the dosing regimen, where appropriate, to a single daily dose instead of several smaller doses per day. The regimen change helps control costs, for both the member and the group, while maintaining effectiveness.

Other initiatives are directed primarily at members, together with their physicians and pharmacists. Under the Member Education Therapeutic Exchange initiative, for instance, Blue Cross is targeting expensive brand-name drugs and educating members about lower-cost alternatives with the same effectiveness (and the same chemical makeup), offering a copay waiver for those who switch to the lower-cost alternative.

In no case will there be an abrupt halt to any prescription currently dispensed. If and when an alternative drug needs to be prescribed, or a currently prescribed drug dispensed differently, the matter will be handled among the member and his or her physician and pharmacy.

Blue Cross Blue Shield of Michigan is in the process of sending members a letter and detailed chart outlining the program.

If any initiative will impact you or a family member, more information will follow directly from BCBSM. In keeping with U.S. Health Information Portability and Accountability Act (HIPAA) guidelines, all specifics will be communicated personally.

Members who have general questions about the overall program or the information in the letter should speak with their physicians or pharmacists.