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Choose Generics & Step-Therapy Effective April 1, 2013

Feb 15, 2013

Aetna will introduce two new cost-saving initiatives to the pharmacy plans for new and renewing groups as of April 1, 2013.

For existing groups, benefit changes will be effective upon each group’s renewal date beginning with April 1, 2013 renewal dates. Aetna will provide notification of these plan changes in the employer group renewal package.

Reason for the Change

When it comes to their medications, members will always have the final choice. However, when a generic option is available, they will pay greater out-of-pocket costs for choosing a more costly medication. Aetna indicates that generic medications normally cost 85% less than the brand versions. It's estimated that a 1% increase in generic dispensing rate (GDR) is equivalent to a 2.5% decrease in plan sponsors' pharmacy costs. Members also get the same quality with generics for less money.

Choose Generics

Choose Generics promotes the use of clinically-effective, cost-saving generic drugs.

If a member is currently takes a brand-name medication, and a generic is available, the member will need to use the generic version at the next refill or pay the cost difference between the two drugs, plus the applicable copay. For new prescriptions, if the prescribed medication is available in a generic form, the member will automatically receive the generic.

If a prescriber writes 'dispense as written', or a member requests the brand-name drug when a generic is available, the member will pay the difference in cost plus the applicable copay.

Step-therapy

Step-therapy promotes the appropriate use of equally effective but lower-cost medications first.

For any given condition, there are many therapy choices. Aetna will help members navigate their choices and find the most effective option, by starting with prerequisite medications. Trying one or more prerequisite medications is required before a step-therapy medication will be covered. Prerequisite medications are approved by the U.S. Food and Drug Administration (FDA) and treat the same condition as the corresponding step-therapy medications.

Members Currently Taking a Step-Therapy Medication

Members currently taking a step-therapy medication, that have an active prescription on file with the pharmacy, can continue filling the same medication without penalty. New prescriptions will be subject to the step-therapy process.

Exceptions to Step-Therapy

The prescriber can ask for an exception if the member has a medical need to use a medication on the step-therapy list. This process takes place within 72-hours of the request.

Please contact your b&p Group Sales Representative to discuss Aetna's Step-Therapy and Generic Drug Options - 888-722-3373

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