Dose Optimization Program

Wellmark Blue Cross and Blue Shield’s Dose Optimization program is designed to increase patient compliance with drug therapies and slow the rising cost of prescription drugs.

Only drugs that have been approved by the Food and Drug Administration (FDA) for once daily dosing and have different strengths available at similar costs are included in the program. An example is a drug in which a 40mg tablet costs the same as an 80mg tablet. Taking one 80mg tablet is more cost effective than taking two 40mg tablets per day.

In some cases, patients' out-of-pocket costs can be reduced by as much as 50 percent.

Drugs Included in the Program

How the Program Works

• Only medications that have similar pricing across multiple strengths and can be taken as a single daily dose are included.
• If the clinician decides a single dose at a higher strength is the right therapy, the clinician will need to write a new prescription for once-a-day-dosing.
• If the clinician wants the member to continue taking the drug at a lower dose more than once per day, the clinician will need to receive approval from Wellmark.
• If the member does not have a new prescription for the higher strength dosage, or if the clinician has not received approval from Wellmark to continue on the current dosage, the claim will deny at the pharmacy.
• To request an override, call 1-800-600-8065 and choose option 1 from 7 a.m. to 7 p.m. Monday through Friday, and 8 a.m. to 5 p.m. Saturday and Sunday.
• You may also complete the Dose Optimization program fax form (pdf) and fax it to 1 (866) 884-4345.

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