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Home / News & IndustryManaged Care Insight and Analysis
Updated: September 21, 2010
Pharmacy Industry P4P Program Being Adopted

Add the pharmaceutical industry to the growing list of health-related industries recognizing the importance of P4P programs.

The Pharmacy Benefit Management Institute (PBMI) awarded four 2010 Rx Benefit Innovation Awards to the 1199 Service Employees International Union (SEIU) Benefit Funds, Blue Cross and Blue Shield of North Carolina, Manatee County (Florida) Government Employee Health Benefits, and Unity Health Plans Insurance Corporation with the Wisconsin Pharmacy Quality Collaborative.

The 1199 SEIU Benefit Funds are being recognized for a cost containment program offering members the most clinically effective medications at no out-of-pocket cost, while achieving a -1 percent drug trend. Blue Cross and Blue Shield of North Carolina (BCBSNC) is being recognized for a program that increased medication adherence in its chronic disease population by minimizing barriers to adherence.

In an era of increased cost-shifting to participants, the 1199 SEIU Benefit Funds provide 420,000 members with access to a range of generic and brand-name drugs at no cost, provided members follow the plan. The Funds’ aggressive management strategies include mandatory generics, mandatory mail-order for maintenance drugs, and a preferred list. If members make choices outside these parameters, they pay out-of-pocket. The approach has engaged members in using their benefits wisely and saved more than $200 million in drug costs since 2005.

BCBSNC implemented member and provider strategies to increase medication adherence in a 100,000-member population with hypertension, high cholesterol, diabetes or congestive heart failure. The plan offered free generics and reduced copayments for certain brand-name drugs. Members received refill reminders and physicians received ePrescribe messages about patient adherence.

Address: Pharmacy Benefit Management Institute, 8679 East San Alberto Dr., Suite 101, Scottsdale, AZ 85258-4368; (480) 730-0814,

  This article was taken from:
Pay-For-Performance Reporter

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