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Pharmacy Initiatives
To help control costs and reduce your out-of-pocket expenses for prescription drugs, the following programs are included under most BCBSM benefit plans.
Preferred Therapy
This program encourages the use of the most cost effective drugs over the higher priced brand-name medications if a prescription for the targeted brand-name medication has not been filled in the last six months (180 days).
Generic Copayment Holiday
This program offers a copay wavier for three retail or one (90-day) mail order copay when members switch to the generic equivalent of a specifically targeted drug.
Dose Optimization
This program encourages the use of select prescription drugs in once-daily dosage regimens when appropriate, which is less expensive than the higher cost multiple daily doses.
Brand-to-Alternate Generic Interchange
This program encourages the interchange of brand-name drugs with less costly generic alternatives.
Generic Copay Waiver
This program offers a one-month copay waiver when members switch to the generic equivalent of a specifically targeted drug.
Quantity Limit
This program restricts the dispensing of targeted drugs in quantities not consistent with the FDA-approved labeling for the drugs.
Off-Label / High-Cost Specialty Review Program
This program disallows coverage for drugs prescribed for uses other than those approved by the FDA and requires a prior authorization review of other high cost specialty drugs.
Questions? We can help!
If you are not sure whether your BCBSM benefits include these programs, please contact customer service.
