Brand Drug Coverage Gets Trimmed To Bare Minimum In New WellPoint Plans

"Generic Premium" plans being introduced by WellPoint for 2009 will cut coverage of brand-name drugs to the bare minimum by allowing members access to one brand in classes with generic options.

The plans will be offered in the employer-based commercial insurance market.

WellPoint has not yet announced the new plans, but in an interview, Chief Pharmacy Officer Brian Sweet described the overarching concept.

"We know that we can't necessarily cover all care with just generics, and if you just have a generic benefit, there may be gaps in the type of care and the availability and the access to the right medications," he said. "So, we've designed a product that really is a generic plus one branded product in all of the major therapeutic areas." In some classes, two brands may be offered.

"The actuaries have been able to look at the savings on it, and both member out-of-pocket could go down dramatically because of the savings on generics and the premium can be reduced for employers," Sweet said. The plan could save members up to 24 percent a month on pharmaceuticals, and premiums could drop up to 5 percent for some employers, he said.

"So, typically if you have employers that are thinking about pulling back on their pharmacy benefit offerings for next year, or if there is a potential that they might not offer any pharmacy benefit, this is a much more affordable benefit for them to consider," Sweet said.

Brands in classes with no generic competition are "typically included," Sweet said.

Employers will have three designs to choose from, with different levels of pricing, Sweet said. One design will include high-cost biotech drugs, for example, and another will have mandatory mail-order prescriptions for maintenance medications.

WellPoint is tackling pharmaceutical costs in its plans in different ways. The company recently unveiled a new Outcomes Based Formulary that asks manufacturers to submit data on cost-effectiveness and impact on pharmacy and medical budgets when submitting drugs for formulary review.

- Scott Steinke ([email protected])