Generic Prescription Drug Plan To Provide Relief For Regence Members

Armen Hareyan's picture
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Rising health care costs are forcing some people to reduce their coverage or drop it altogether. To provide relief, Regence BlueCross BlueShield of Oregon has introduced a Generics First Antidepressant Program.

The program encourages the use of high-quality generic medications that have proven track records. "The antidepressant market has substantially changed over the last several years," said David Clark, vice president of Medical Services and Pharmacy for Regence. "More generic antidepressants are available for the majority of patients. Evidence indicates that most antidepressants are equally effective when comparable doses are used, we're encouraging our members and physicians to consider generic drugs when prescribing antidepressants for the first time."

Because generics can meet the needs of most patients, new prescriptions for name-brand drugs Cymbalta, Lexapro, Paxil CR, and Effexor XR need prior authorization beginning in September. Prior authorization means Regence must authorize coverage for the prescription under a member's prescription drug plan. Prior authorization is not necessary for members already on these medications. For members starting on one of the brand-name antidepressants listed, Regence has asked physicians to prescribe a generic antidepressant such as citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, mirtazapine or bupropion SR first.

"These generics are a good value for members and are available without prior authorization," said Clark, who pointed out that a 30-day prescription of a brand-name drug can cost as much as $83 while the same prescription of that drug's generic equivalent is only $30.

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Clark said the continuously rising cost of prescription drugs caused Regence, a not-for-profit company, to create its own in-house Pharmacy Benefit Management (PBM) function for its four affiliate Blue Cross and/or Blue Shield Plans.

Since the formation in 2000 of RegenceRx, one of the few not-for-profit PBMs in the country, the cost of managing drug benefits has dropped. Dollars gained through the use of RegenceRx are used to help keep the cost of health coverage as low as possible, and the focus of RegenceRx on lower net costs has saved Regence and our customers more than $400 million since 2000.

Clark said RegenceRx performed an extensive analysis of the scientific data and relative costs for the antidepressant class. Besides treatment in depression, some antidepressants are also indicated for other conditions, including anxiety, obsessive-compulsive and panic disorder, social phobia, bulimia nervosa, and post-traumatic stress disorder. For the majority of patients with these conditions, a generic antidepressant provides effective treatment.

"We focus on getting the right medication to the right patient, saving money whenever appropriate," Clark said. "With the dramatic rise in health care costs, that's become increasingly important. One of the simplest things you can do to save on medical expenses is to remember to ask your doctor or pharmacist if there's a generic alternative for any prescription drug you are taking."

Clark acknowledged that some people may be skeptical of lesser-known generic drugs, but said, "The Food and Drug Administration requires that generics meet the same strict standards of safety and effectiveness as the equivalent brand name drug. The generic may be a different shape or color than the expensive brand name, but the active ingredients inside remain the same and that's what's important."

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