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WELCOME TO NEWS FROM BLUE,SM CREATED TO HELP YOU BETTER MANAGE YOUR HEALTH PLAN BY KEEPING YOU UP-TO-DATE ON THE LATEST INFORMATION FROM WELLMARK BLUE CROSS AND BLUE SHIELD. NEWS FROM BLUE WILL BE E-MAILED TO YOU MONTHLY, AND ARCHIVED ON WWW.WELLMARK.COM.
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Wellmark Drug List ChangesEffective July 1, 2007, Wellmark Blue Cross and Blue Shield is moving nine medications from Tier 2 to Tier 3 on the Wellmark Drug List on www.wellmark.com. In late May and early June, Wellmark mailed notification of these changes to your employees on a three-tier drug plan who have filled a prescription since January 1, 2007, for one of the listed drugs.* Your employees continue to have benefits for Tier 3 drugs; however, their out-of-pocket costs may be higher. The online searchable Wellmark Drug List and the accompanying printable condensed version will be updated July 1 when the tier changes go into effect.AB-Rated Generics Available
Brand-Name Drugs Moving to Tier 3 Brand-Name Drugs That Moved to Tier 2 * Members not notified about these drug tier changes because they are antibiotics and are for acute use. |
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Generic Ambien (zolpidem tartrate) is now available, creating significant cost-savings. Several generic manufacturers have entered the market, resulting in a substantial decrease in the average cost per prescription.
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Drug Name |
Number of Tablets |
Price* |
Ambien 5mg |
30 |
$134.12 |
zolpidem tartrate 5mg |
30 |
$15.39 |
Ambien 10mg |
30 |
$134.12 |
zolpidem tartrate 10mg |
30 |
$19.39 |
Both Ambien and Sonata will move from Tier 2 to Tier 3 of the Wellmark Drug List effective July 1, 2007. A postcard was mailed to your employees who have filled a script since January 1, 2007, for Ambien, Sonata, Ambien CR, Lunesta, and Rozerem about the availability of generic Ambien and the July 1, 2007, Wellmark Drug List change to move Ambien and Sonata from Tier 2 to Tier 3. According to Drug Topics, Ambien was the 13th highest-selling brand-name drug in 2006 with annual reported sales of $1.7 billion.
Generic Drug Prices: It’s All About Exclusivity
Why are some generic drug prices considerably less expensive than their brand-name counterparts as soon as they are available while other generic drugs cost almost the same as the brand-name drug? It all depends if an exclusive manufacturing period gets awarded to one manufacturer. In that case, only one manufacturer is allowed to make the generic version of the drug for 180 days. These drugs are often referred to as exclusive orauthorized generics. During that time, the price is only about 10 to 20 percent lower than the brand-name counterpart.
If, however, the brand-name patent expiration has been legally upheld, the Food & Drug Administration (FDA) may grant approval to several manufacturers to make generic versions. In the case of Ambien, 13 manufacturers were given generic manufacturing approval, causing the price to immediately plummet.
When there are multiple manufacturers, a Maximum Allowable Cost (MAC) is established by each pharmacy benefit manager (PBM) or carrier. The MAC represents the
maximum amount the pharmacy will receive for dispensing the generic version of
specified drugs on the list. Since each PBM or carrier can establish the payment schedule, the cost of generic drugs will vary based on the PBM’s or carrier’s pricing strategy.
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If you need additional information, contact your Wellmark Account Manager or broker. In addition, worksite marketing materials can be found in the Decisions Count® Employer Toolkit on www.wellmark.com to educate your employees on how generics can help save money. |
New PPI Step Therapy Program Changing Utilization Patterns
Good news! The new proton pump inhibitor step therapy program that Wellmark Blue Cross and Blue Shield implemented on May 1 is having immediate results.
Members have increased their utilization of Tier 1 PPI’s, omeprazole and Prilosec OTC, while decreasing their utilization of the more expensive Tier 3 PPI’s such as Nexium, Protonix, and Aphicex. Click here to see a graph of utilization statistics from July 2006 through mid May 2007. |
If you need additional information on the step therapy program, contact your Wellmark Account Manager or broker. |
Reminder: Date of Event Determines Cancellation Date
When submitting member cancellations (e.g. termination of employment, death, dependent marriage. etc) via the Group Membership Change form or on a prior month’s Group Statement, you should enter the actual date of the event rather than the expected cancellation date. By doing this, you will:- Expedite member maintenance processing
- Reduce inquiries from Wellmark
- Promote administrative efficiency
Wellmark determines cancellation dates based on event dates. For example:
Date of Event |
Wellmark Receipt Date |
Wellmark Processed Cancel Date |
July 31 |
August 4 |
August 1 |
September 15 |
September 18 |
October 1 |
May 22 |
June 10 |
June 1 |
February 1 |
February 9 |
March 1* |
If cancellations are not received in a timely manner, cancellation dates will be limited to three months prior to the date Wellmark is notified. For example:
Date of Event |
Wellmark Receipt Date |
Wellmark Processed Cancel Date |
May 10 |
September 10 |
July 1 |
October 1 |
January 20 |
November 1 |
June 1 |
December 1 |
October 1 |
Electronic Submissions
You may submit cancellations electronically by accessing Member
Maintenance at www.wellmark.com. When doing so, the cancel date entered indicates the date claims will pay up
to, and not through. Consequently, a request to cancel a member
at the end of the month would be submitted with a first of the
following month cancel date (for example, a request to cancel a
member terminating employment on August 31 would be submitted
with a September 1 cancel date).
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Please refer to your Enrollment and Administrative Guide for additional information on submitting cancellations. |
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