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Blue Cross Blue Shield of Michigan Now Covers Prilosec OTC - Switching from Nexium Could Save Eligible Members More Than $9 Million in Out-of-Pocket Costs
Move to Prilosec from brand name drug for treatment of heartburn and acid reflux is encouraged by the Blues for eligible members
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DETROIT, September 5, 2007 - Blue Cross Blue Shield of Michigan has begun paying for over-the-counter Prilosec® and is encouraging a switch to Prilosec OTC or generic Prilosec for eligible members using the prescription drug Nexium® for heartburn and acid reflux disease.
The switch will save out-of-pocket costs for eligible Blues members, and member out-of-pocket savings may total $9 million overall, according to Blues estimates. Eligible Blues members switching to Prilosec OTC or the generic version of Prilosec from Nexium will pay nothing for the first prescription/supply of the drug, and they only will pay their normal generic drug copayment for subsequent prescriptions.
The new benefit applies to approximately 1.5 million BCBSM members whose customer groups have agreed to the new program. Not all customer groups have agreed, and members should check with their benefits administrator to confirm their employer's participation, and with their physician to confirm whether the switch is right for them. This is the latest in a series of efforts by BCBSM to identify and encourage ways that Blues members can continue to receive quality health care at lower costs.
The savings for each member will depend on several variables, including their copayment levels and frequency of use. A Blues member whose monthly copayment is $10 for a generic drug and $20 for a brand name drug could save around $130 a year using Prilosec OTC or generic Prilosec instead of Nexium. The savings are calculated on the basis of a year's supply of a brand name drug.
Employers in the program could save nearly $20 million in aggregate drug ingredient costs in the first year, helping slow the growth of prescription drug cost trends. Nexium is one of the most widely-prescribed drugs.
"The majority of our members will find that over-the-counter or generic Prilosec will provide the same benefit as the brand name. We encourage them to discuss making this change with their doctor," said James Lang, Blues vice president for pharmacy services. "By encouraging the use of an effective over-the-counter drug over a more expensive medication, we help to keep down the cost of health care while maintaining the quality of care."
"The price for the over-the-counter drug is less than 25 percent of the cost of the brand name medication," said Atheer Kaddis, Blues director of clinical pharmacy services.
"This is a welcome pharmacy policy change on the part of Blue Cross," said Bruce Carl, M.D., a family practitioner in Romeo and associate medical director of St. John Health. "For many of my patients with heartburn and acid reflex, Proton Pump Inhibitors are maintenance drugs. These patients will be on these medications for years, even for a lifetime. I have often been able to control these medical conditions with Prilosec OTC. I look forward to helping my patients make the switch from Nexium to Prilosec which should save them and their employers real dollars, thus making health care more affordable."
The move to promote effective but less costly over-the-counter alternatives is the latest in a series of concerted, ongoing efforts by BCBSM to help keep prescription drug coverage as affordable as possible for employers and members. Since 2001, BCBSM has implemented programs to increase generic prescription drug use. This has saved Blues customers and members more than $500 million.
For BCBSM members whose groups have elected to participate in the new program, they must give their pharmacist a prescription from their physician to be covered for Prilosec OTC or generic Prilosec. The Blues member then will pay nothing for the first prescription and the same copayment they would pay for a generic drug for subsequent prescriptions. Blues members can purchase Prilosec OTC at a pharmacy without a prescription but the member will then have to pay the retail price and that cost is not reimbursable.
As part of the program, BCBSM is communicating with physicians who have patients using Nexium. Physicians will be asked to transition patients to generic Prilosec over the next several months unless there is a medical reason not to as determined by the prescribing physician and BCBSM.
Members in Blue Care Network, the Blues' affiliated HMO, also can receive Prilosec OTC for a generic copayment. Further information about the cost savings of generic drugs can be found at www.theunadvertisedbrand.com, a Web site launched by BCBSM to provide information to consumers on how they can save on drug costs.
Blue Cross Blue Shield of Michigan, a nonprofit organization, provides and administers health benefits to more than 4.6 million members residing in
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