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It's a new medication adherence program from Blue Cross and Blue Shield of North Carolina (BCBSNC) designed to help employees with specific chronic conditions take their medications as prescribed by their health care provider. Since cost can be a significant barrier to taking medications as directed, BCBSNC is waiving the copayment for generic medications that treat the following conditions: congestive heart failure, high blood pressure, high cholesterol and diabetes. BCBSNC is also moving certain brand-name drugs that treat those same conditions to a lower drug level tier to make them more affordable.

Many people do not realize how important taking their medications as prescribed is to the management of their condition. Rates of non-adherence with medication treatments are estimated to be as high as 50 percent.(1) Studies show that failure to take medications as directed results in the loss of approximately 125,000 lives a year from cardiovascular disease alone, and places a $100 billion burden on the health care industry.(2) Employees with specific chronic conditions who do not take their medications as prescribed may render their treatment ineffective and potentially endanger their health.

Employees who fill prescriptions for congestive heart failure, high blood pressure, high cholesterol and diabetes are eligible to receive the drug tier cost changes. The generic copayment waiver is available only to members of fully-insured groups and self-funded (ASO) groups that have opted-in to this part of the program.

No application is necessary. Employees only need to take their prescription and their BCBSNC ID card to a participating pharmacy. The copayment waiver is applied automatically when an employee fills a prescription for a generic drug that treats any of the specific chronic conditions covered under Medication Dedication. If the prescription is for a brand-name drug that has been moved to a lower drug tier, the cost savings will be applied automatically at the pharmacy as well.

The program begins January 1, 2008 and is expected to run through 2009.

BCBSNC wants to make it easier for employees with specific chronic conditions to stay on their medications as prescribed by making those medications more affordable. We believe Medication Dedication will help keep employees healthy while reducing overall medical costs.

If your pharmacy benefit has a coinsurance benefit instead of a copayment, it will be waived.

Only coinsurance amounts and copayment amounts will be waived. Deductible amounts must be met before eligibility for copayment and/or coinsurance waivers is possible.

Any FDA-approved generic drugs that treat congestive heart failure, high blood pressure, high cholesterol and diabetes (both new prescriptions and refills that are filled beginning January 1, 2008) are eligible for the copayment waiver. For a complete list of the generic drugs covered under Medication Dedication, view the complete Copayment Waiver Drug List (30 KB).

Yes. The waiver applies to both refill prescriptions and new generic prescriptions that are filled beginning January 1, 2008.

No. The program only applies to generic prescriptions filled on or after January 1, 2008.

Tier 3 brand name medications that do not have a generic equivalent and are used to treat congestive heart failure, high blood pressure, high cholesterol and diabetes will be moved to Tier 2 on the formulary.(3) For a complete list of these drugs, view the complete Formulary Change Drug List (22 KB).

While there are no current plans to expand at this time, Medication Dedication may include additional chronic conditions after the program has been fully implemented and evaluated.

These particular conditions have been identified as focus areas for BCBSNC, based on their prevalence and overall impact to medical costs. Research focused on these conditions have shown that improved health is possible with increased medication adherence.(4)

A generic drug is the same as its corresponding brand-name version when it comes to active ingredients, dosage, strength, safety and performance, yet it typically costs up to 80 percent less.(5) A generic drug usually becomes available after the patent for the brand-name version expires.

According to the FDA, generic drugs are the same as their brand-name counterparts in active ingredients, dosage, safety, strength and performance.(6) The only noticeable differences in generics and brand-name medications may be the shape or color of the drug. Plus, generics can cost up to 80 percent less than brand-name drugs.

Generic drugs are FDA-approved and meet the same standards of safety and effectiveness as brand-name drugs. Generics have the same active ingredients, dosage, strength and performance as their corresponding brand-name version.

Health care providers or pharmacists can help employees determine whether the drug being taken is brand name or generic. Employees can also go to Find drug info for more information on brand-name drugs and generics.

No. The purpose of Medication Dedication is to improve medication adherence by encouraging employees and their health care providers to consider generic alternatives when they are available and appropriate, and to help make drug costs more affordable. BCBSNC is also placing brand-name drugs that treat specific chronic conditions into a lower copayment category to make them more affordable.

Yes. BCBSNC covers virtually all FDA-approved drugs. However, we encourage employees to consider generic drugs, when appropriate, in consultation with their health care provider.

Yes. BCBSNC's pharmacy claims system is configured to automatically waive any copayment amount on a generic drug under Medication Dedication, whether filled through mail order or at a retail pharmacy.

Yes. For refills and new prescriptions, the employee's copayment amount for an applicable generic drug will be waived in either situation.

If employees call to fill their generic prescriptions for a 90-day supply on or after January 1, 2008, their 90-day copayment amount will be waived. Please note, however, that benefit rules still apply. This means that employees may only receive a 90-day supply of drugs in a 90-day period.

As long as Medication Dedication is in effect. For example, if a 90-day mail order drug request is submitted between January 1, 2008 and December 31, 2008, the employee will have the 90-day copayment waived.

If the prescription allows for a generic substitution, then typically the mail order pharmacy will dispense a generic version. However, to ensure the full advantage of the waiver, employees should have their physician indicate on the prescription that a generic substitution is permitted.