CHAINS and BUSINESS

Health plans expand generic discount programs for members

These days, getting members to switch to generic drugs is very much on theminds of cost-conscious managers of health plans.

WellPoint Health Networks, Thousand Oaks, Calif., recently launchedGenericSelect, a generic alternative program that allows its members to obtainselect generic drugs at a discount of up to $10 off their co-pay for theirfirst prescription when they begin a new drug therapy with a GenericSelectdrug.

The program emphasizes not only the generic version of the equivalent brandname, but also generic drug substitutes for brand-name drugs within atherapeutic class.

The GenericSelect drug list includes fluoxetine for depression; lovastatinfor high cholesterol; ranitidine tablets for acid reflux; lisinopril, atenolol,hydrochlorothiazide, and chlorthalidone for high blood pressure; metformin fordiabetes; and ibuprofen and naproxen for arthritis pain.

Robert Seidman, the firm's v.p. and chief pharmacy officer, told DrugTopics, "Our responsibility is to ensure the affordability ofprescription drugs. We know certain therapeutic classes are responsible fordriving a significant portion of drug trend. We know there are genericallyapproved drugs in these classes that have received wide exposure inpeer-reviewed journals. These widely used gold standard drugs should be thefirst line of therapy for the vast majority of patients who have thesediseases."

Emphasizing that the pharmaceutical industry "spends $15 billion a yearsampling drugs, detailing physicians, and taking out direct-to-consumer [DTC]ads," Seidman said money is not being spent on encouraging the utilizationof generic drugs. "There are 88,000 physician representatives calling ondoctors and talking exclusively about brand-name drugs. It's important to givegeneric drugs a voice," he asserted.

WellPoint has sent letters to 86,000 of its members in California informingthem of the program and the benefits of generic drugs. Letters will also besent to members of Blue Cross and Blue Shield of Missouri, Blue Cross and BlueShield of Georgia, and UNICARE.

"If we do nothing, prescription drug costs will double in five years.Many employer groups will drop out [of health plans]. If we succeed inincreasing generic use, we'll be able to postpone the day of doubling Rx costs.We want to defer that date as far into the future as we can," saidSeidman.

WellPoint piloted GenericSelect January 2002 through July 2002 with genericMevacor (lovastatin). "We took generic use from 0% to 4%. Every 1%increase saves us $300,000 a year," said Seidman.

In the area of hypertension, WellPoint is pushing the use of chlorthalidoneand diuretics as first-line therapy, in line with articles in the Journal ofthe American Medical Association. "I have five million members inCalifornia," Seidman said. "Prior to the launch of GenericSelect, Ihad 300 scripts per quarter for chlorthalidone. Everyone forgot aboutchlorthalidone. The patent expired 25 years ago."

Not to be outdone, Blue Cross Blue Shield of Michigan recently expanded itsPreferred Generic Coupon program. Piloted from January 2002 to June 2002, theprogram offers members a coupon for co-pay waivers if they switch from brand togeneric drugs. "There are more than 30 drugs on the coupon, including somedrugs that recently became available, such as Glucophage and the hypertensiondrugs Prinivil and Zestril," said Atheer Kaddis, Pharm.D., director ofpharmacy services, Blue Cross Blue Shield of Michigan.

Kaddis said that in the pilot program coupons were mailed to more than 7,000insured members. "We had a 10% conversion rate over to the generic withthis program," he said. "Overall, we waived about $7,000 in co-pays.The overall generic conversion for the members saved us $190,000. The programis currently rolling out to 10,000 insured members and will be expanded toinclude an additional 10,000 self-funded groups."

Encouraging generic use is also a high priority with the Virginia Plan ofAnthem Blue Cross and Blue Shield, which has had a mandatory generics programfor four years. Ron Lyon, R.Ph., v.p. of pharmacy, told Drug Topics,"Our generic percentage was 37% of total scripts. Now it is running about45% of total scripts. There's very little public concern about the quality ofgenerics."

The Virginia Plan of Anthem has three drug tiers-generics, good-value brandnames, and high-cost medications. The company placed some good-value brand drugs,such as Astelin nasal spray, on the generic tier and, according to Lyon, theproduct is very effective in treating allergies and is less expensive thanClaritin, Allegra, or Zyrtec. Lyon explained that the use of good-valuebrand-name drugs would result in significant savings for members and for theVirginia Plan of Anthem.

Sandra Levy

Sandra Levy. Health plans expand generic discount programs for members.

Drug Topics

2003;3:66.