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) helps people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 33 million people. It is collectively owned by 19 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.

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