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Preferred Drug List Question & Answer

Q) What is a preferred drug list?
A) A preferred drug list is a listing of agents that physicians of the Pharmacy & Therapeutics Committee developed to promote quality health care while reducing unnecessary costs.

Q) Why was the preferred drug list developed?
A) This list was developed to guide the physician and patient in selecting medications with the most therapeutic value. In many cases, similar drugs treat the same medical condition. These drugs provide similar effectiveness and similar safety; however, they are available at a variety of prices. Higher priced drugs that do not provide additional value (as documented in unbiased medical research) are typically excluded from the preferred drug list. These drugs, which are not included on the list, are called non-preferred drugs.

Q) How was the preferred drug list developed?
A) A committee of physicians developed the Regence BlueCross BlueShield of Utah preferred drug list. These physicians, representing general practitioners and five board- certified specialties, periodically review each major class of drugs and evaluate new products.
The criteria for evaluating and selecting drugs include

·         Efficacy- A drug's ability to treat a condition or prevent a disease.

·         Safety- The incidence of side effects and drug interaction.

·         Cost- Cost is the last consideration, after the first two criteria are met.

Q) Are all generic drugs on the preferred drug list?
A) Yes.

Q) How will my physician know which drugs are preferred?
A) Regence BlueCross BlueShield of Utah mails physicians a copy of the preferred drug list every year. Throughout the year, physicians receive additional material regarding drugs on the preferred drug list and the clinical logic behind the preferred selections.

Q) Do all non-preferred drugs have preferred alternatives?
A) Thousands of drugs are preferred, while very few are non-preferred. For every non-preferred drug, preferred alternatives are available. Check with your physician.

Q) How can I review the preferred drug list to assist my physician?
A) Regence BlueCross BlueShield of Utah can provide you with a short list of non-preferred drugs. Please share this list with your physician and discuss the use of preferred alternatives. Drug selection is a physician/patient decision.

Q) I am currently on a drug that requires a non-preferred co-payment/coinsurance. What should I do?
A) You and your physician have two choices:
Review the non-preferred drug list and select an alternative that is preferred.
Decide to remain on the non-preferred drug and pay the higher co-payment/coinsurance.

Q) Are non-preferred drugs still a covered benefit?
A) Yes. Non-preferred drugs are still covered, but at a higher co-payment/coinsurance than alternatives on the preferred drug list. Benefits for a non-preferred drug may vary.

Q) Can I get special approval to pay a preferred co-payment/coinsurance for my non-preferred drug?
A) No. However, the therapeutic committee reviews new data regarding medications as it is published in well-respected medical journals. Changes to the preferred drug list may take place at that time.

Q) Who will be notified if my drug is added to or removed from the preferred drug list?
A) Although the preferred list remains stable, changes may take place. Physicians and pharmacists will be notified of these changes.

Q) My benefit has a lower co-payment/coinsurance for generics. What if no generic alternative is available?
A) If a generic is not available, you will be required to pay the higher preferred or non-preferred co-payment. Discuss using a preferred drug with your physician. Generic drugs are used to treat many medical conditions, and when available, generic drugs are safe and effective. Generics are particularly effective in the areas of antibiotics, pain and arthritis, and blood pressure. Check with your physician to see if a generic drug is available.

Preferred Drug List
This list presents alternatives to non-preferred drugs.
The selection of therapy is a physician/patient decision.

Updated 4/15/2003

ACCUTANE is considered a non-preferred drug.


NON-PREFERRED ANTIBIOTICS: AUGMENTIN XR, BIAXIN, BIAXIN XL, CECLOR CD, CEFTIN SUSPENSION, DYNABAC, FLOXIN, KEFTAB, LEVAQUIN, LORABID, OMNICEF CAPS, SUPRAX, TEQUIN

The above list is subject to change without prior notification.

 
Newly Approved (FDA) medications which are currently deemed Nonformulary by Regence BlueCross BlueShield of Utah
Updated 6/13/2003

The above list is subject to change and will be updated as needed.

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