Perspectives

An extra tier for generics helped the medicine go down (in price)

When member cost share for generics went down, member adherence went up.

September 21, 2018

A sixth tier on the formulary helped some of our Blue Plans with Medicare contracts reduce member cost share for targeted generic drugs. We picked medicines CMS had identified as part of its Star adherence program. Member cost share changed from $4 or more to $0-$2 per 30-day supply. Adherence improved for the drugs that treat high blood pressure (1.4 percentage points), cholesterol (1.5 percentage points) and diabetes drugs (1.4 percentage points).

Can Lowering Generics Member Cost Share Impact CMS Star Adherence Metrics? (2018)

About Prime Therapeutics

Prime Therapeutics LLC (Prime) is a diversified pharmacy solutions organization serving health plans, employers and government programs. Prime is collectively owned by 19 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Magellan Rx Management LLC, a Prime Therapeutics LLC Company, is a pioneer in specialty and medical drug management and a leader in serving public sector state government programs. Together Prime and Magellan Rx provide a wide range of clients with solutions that bridge the distance between medical and pharmacy management. For more information visit primetherapeutics.com and magellanrx.com or follow us on X (Twitter) at @Prime_PBM and @Magellan_Rx.

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