By focusing on clinical effectiveness and supplying the right drug for the right reason, at the right time, we can work together to positively impact your and your employees’ health care dollars.
Wellmark Blue Cross and Blue Shield offers up to five different pharmacy plan designs, depending on a few factors like employer size and funding arrangement. Ranging from managed to broad access, each plan uses the Wellmark Drug List Opens in a new window in a tier or level structure. To determine the appropriate tier or level of a drug, the Wellmark Pharmacy & Therapeutics (P&T) Committee Opens in a new window evaluates safety, effectiveness, cost and comparative benefits of similar drugs. The more managed a plan is (i.e., fewer tiers or levels), the greater the savings potential.
Blue Rx BasicSM
Tier 1 Drugs
Covers primarily generic medications, which cost less than brand-name drugs.
Blue Rx ValueSM
Tier 1 & 2 Drugs
Provides access to a set of “best-value” medications, including generic and preferred brand-name drugs.
Blue Rx Value PlusSM
Tier 1, 2 & 3 Drugs
Provides access to generic medications and a broad selection of preferred and non-preferred, brand-name drugs.
Blue Rx CompleteSM
Tier 1, 2, 3 & 4 Drugs
Traditional drug plan with no restrictions on drug selection.
BlueSimplicitySM Rx
Level 1, 2, 3, 4 & 5 Drugs
Innovative drug plan with emphasis on a drug’s true value, or safety, effectiveness and relative cost.
Cost share, or the flat fee paid at the pharmacy by an employee, is usually linked to each plan tier. In a three-tier plan, for example, a Tier 1 drug could cost $10 and a Tier 3 could cost $60. These copays can be adjusted to meet your specific benefits goals and needs with help from your Wellmark representative.
Since all these options are based on the Wellmark Drug List, any plan you choose will emphasize smart drug choices that cost your employees less without sacrificing effectiveness and safety.
Learn more about the different ways you can personalize your pharmacy benefits program to best serve your employees and your organization’s bottom line:
- Understanding pharmacy costs to create a sustainable future
- Choosing a pharmacy network that works
- Using utilization management to improve health
Questions? Contact your Wellmark representative for more.
