Keeping Costs Low

Controlling Prescription Drug Costs

Working With Physicians and Hospitals | Coordinating Care

Drug costs have increased 40.9% for Wellmark and its members since 1998. Nearly 16% of your health premium dollar is spent on prescription drugs. Wellmark is continually looking for ways to curb increasing drug costs.

AdvancePCS

Wellmark contracts with America’s largest pharmacy benefit manager, AdvancePCS. AdvancePCS:

• Negotiates the lowest possible payment rates directly with pharmacies.
• Provides utilization reports for pharmacies to help them control rising drug costs.

Drug plan options

Wellmark has a wide range of pharmacy plans and programs in place to control escalating drug costs. On average, generic drug costs are 1/3 the cost of brand name drugs. The move toward choosing generics instead of brand-name drugs is a necessary step in keeping prescription costs down.

Our three-tier Blue Rx drug plans encourage the use of generic drugs. Within the Blue Rx drug plans, each prescription drug is placed on a copayment level:

	Tier		Copayment Amount		Prescription Drug Type
	First Tier		Lowest		Generic drugs
	Second Tier		Intermediate		Specially selected brand name drugs
	Third Tier		Highest		All other brand name drugs

The member’s payment responsibility depends on how the drug is listed in the Wellmark Drug List.

Analyzing drug usage

From 1999 to 2003 Proton Pump Inhibitor (PPI) drug usage increased 253 percent by Wellmark members.

Much of this growth can be attributed to new drugs on the market such as Prilosec, Prevacid, and Nexium that cost nearly $5 a pill. In 2003, Wellmark members took more than $35 million worth of PPI drugs, with Prevacid and Nexium accounting for $20.6 million.