May 16, 2012
BCBSIL Introduces 2012 Prescription Drug Program Changes (2-150 and 151+ BluePrintSM) Beginning July 1, 2012 [Group Markets]
As reported on April 4, Blue Cross and Blue Shield of Illinois (BCBSIL) is making enhancements to standardized plans for our 2-150 and 151+ BluePrint business. Beginning July 1, 2012, we will implement a 4-tier optimal plan design of $8/$35/$75/$150 with the Generics Plus formulary as part of the standard product plan offering. These enhancements are also available, either together or independently, as an option to custom fully insured and ASO groups.
4-Tier Optimal Plan Design The 4-tier optimal plan design allows for distinction between preferred specialty and non-preferred specialty drugs on the formulary. The design also changes member cost-sharing for specialty medications. Each tier is defined as follows: Tier 1 – generic medications Tier 2 – preferred brand medications (not including specialty drugs) Tier 3 – non-preferred brand medications and preferred specialty medications Tier 4 – non-preferred specialty medications
The 4-tier optimal plan design is intended to help manage the increasing cost of specialty medications, allowing employers to maintain prescription drug coverage and control out-of-pocket expenses for members.
How It Applies to Groups: Fully Insured 2-150 and 151+ BluePrint (Standardized Products): Optional for effective dates beginning July 1, 2012 151+ New and Renewing: Optional for effective dates beginning Jan. 1, 2012 ASO New and Renewing: Optional for effective dates beginning Jan. 1, 2012
Generics Plus Formulary Generics plus is adapted from the current standard formulary and is being implemented in response to the demand for lower-cost product offerings. Generics plus reflects the increased availability of generic drugs and includes brand medications that have demonstrated therapeutic advantages over other agents. Please refer to the BCBSIL website to review both the 2012 Standard Formulary List and the 2012 Generics Plus Formulary List.
How It Applies to Groups: Fully Insured 2-150 and 151+ BluePrint (Standardized Products): Optional for effective dates beginning July 1, 2012 151+ New and Renewing: Optional, but recommended for groups selecting 4-tier plan for effective dates beginning Jan. 1, 2012 ASO New and Renewing: Optional, but recommended for groups selecting 4-tier plan for effective dates beginning Jan. 1, 2012
Please note the following impacts concerning the 4-tier optimal plan design/Generics Plus formulary: There are 324 drugs moving to brand non-formulary. That number includes specialty and non-specialty in all formulary dosages, and represents 156 unique drugs. Out of these 156 unique drugs, the top 10 will impact approximately 50 percent of affected claims and the top 15 will impact 61 percent of affected claims. The top 15 impacted drugs are: 1) Singulair, 2) Lexapro, 3) Nexium, 4) Advair Diskus, 5) Nasonex, 6) Diovan, 7) Diovan HCT, 8) Ortho Tri-cyclen Lo, 9) Vyvanse, 10) Tricor, 11) Nuvaring, 12) Celebrex, 13) Benicar, 14) Benicar HCT, 15) Januvia. A total of 90 drugs are moving to brand formulary from brand non-formulary. Affected claims: 12.8 percent of affected claims would be impacted by the move from 3-tier and 4-tier, with 12.3 percent of affected claims moving from brand formulary to brand non-formulary and 0.5 percent affected claims moving from non-brand formulary to brand formulary.
Plans Closing In addition to the implementation of the 4-tier optimal plan design, the following HCA (health care account) or high deductible plans will be closed to new business, beginning July 1, 2012.
BlueEdgeSM HCA Direct Plans RPD92615, NPD92615, RPDA2435, NPDA2435, RPD93615, NPD93615, RPDA3435, NPDA3435, RPD91127, NPD91127, RPD93625, NPD93625, RPD91137, NPD91137, RPD92635, NPD92635
BlueEdgeSM HCA Select Direct Plans RBD92615, NBD92615, RBDA2435, NBDA2435, RBD93615, NBD93615, RBDA3435, NBDA3435, RBD91127, NBD91127, RBD92625, NBD92625, RBD93625, NBD93625, RBD91137, NBD91137, RBD92635, NBD92635
BlueChoice Select® Plans RBPE2326, NBPE2326, RBPE2324, NBPE2324, RBPE3436, NBPE3436, RBPE3434, NBPE3434
BlueEdgeSM HSA Plans RPSE1A07, NPSE1A07, RPEE1907, NPEE1907, RPSH1807, NPSH1807, RPEH1807, NPEH1807
PPO ValueChoice Plans RPVE3905, NPVE3905, RPVH3805, NPVH3805
CPO ValueChoice Plans RCVG2805, NCVG2805
PPO Plans NPPE2326, NPPE2324, RPPE2426, NPPE2426, RPPE2424, NPPE2424, NPPE3326, NPPE3324, NPPE3526, NPPE3524, NPPE3336, NPPE3334, NPPE3536, NPPE3534, RPPE3436, NPPE3436, RPPE3434, NPPE3434
For questions or further information, please contact your BCBSIL representative.