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July 2016
Blue Cross not covering select high-cost drugs with comparable alternatives
To address the high cost of drugs and provide the best value for our members, Blue Cross Blue Shield of Michigan commercial plans will no longer cover select high-cost, U.S. Food and Drug Administration-approved drugs for which more cost-effective therapeutic alternatives are available. This doesn't apply to Michigan Education Special Services Association members.
The initial drugs targeted for this initiative are Jublia®, Kerydin® and Onmel®, a group of medications used to treat onychomycosis, or toenail fungus. These drugs will no longer be covered beginning Aug. 1, 2016.
The following table includes the approximate cost of the brand-name drugs and associated therapeutic alternatives:
Brand-name drugs not covered beginning Aug. 1, 2016, and their costs** |
Therapeutic alternatives and their costs** |
Jublia topical solution (eficonazole) |
$1,290 |
ciclopirox topical solution (Penlac®) |
$50 |
Kerydin topical solution (tavaborole) |
$1,614 |
terbinafine tablet (Lamisil®) |
$390 |
Onmel tablet (itraconazole) |
$1,164 |
itraconazole capsule (Sporanox®) |
$557 |
**Approximate cost for a 30-day supply based on the average wholesale price.
In some cases, members’ out-of-pocket costs for these brand-name drugs may be lower than their copay due to manufacturer savings cards. However, the high cost of these drugs is reflected in future premium rates and may affect the claims experience for both members and plans.
As part of this ongoing initiative, Blue Cross will continue to identify select high-cost drugs and will stop covering them when there are more cost-effective alternatives available for our commercial members.
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