In an effort to ensure your employees receive full optimization of their pharmacy benefits, Horizon Blue Cross Blue Shield of New Jersey will be launching new Dispense As Written (DAW) system edits on January 1, 2010. This change has been designed to increase awareness of rising health care costs and to ultimately help control this problem by encouraging generic substitutes when applicable.

WHAT THIS MEANS TO YOU AS AN EMPLOYER?
Two DAW system rules will be in effect:

• DAW1: If a provider prohibits the patient from receiving a generic substitute for the brand name drug, he or she must write “Dispense As Written” on the prescription.
  
  
• DAW2: A patient may request that he or she receive a brand name drug rather than the generic substitute.

For prescriptions for drugs and products requiring prior authorization, the provider must demonstrate medical need for any DAW1 cases in which the patient must receive the brand name, before the lower copayment will apply.

Currently a drug copayment is determined by what tier the drug falls under; however, under the new DAW system, for any DAW2 cases in which a patient indicates he or she does not want a generic substitute, or if medical need is not demonstrated, the patient will be responsible for the difference between the cost of the brand name drug and the generic substitute, plus the generic copayment.

With the new DAW system edits in place, overall health care costs may see a decrease, as FDA-approved generic substitutes cost an average of 30 percent to 80 percent less than brand name drugs. In addition, plan costs may be reduced by 1 percent for every 1 percent increase in the overall dispensing rate of generic substitutes.

Starting January 1, 2010, fully-insured members with prescription benefits that require prior authorization will be subject to the conditions of the DAW1 system; DAW2 will be in effect for all fully-insured members, regardless of prior authorization requirements.

The new Advantage Formulary will also be introduced at this time. This will encourage patients to first use generic substitutes in nine therapeutic classes.

WHAT SHOULD I DO NEXT?
Please communicate this important information to your enrolled employees. To review Horizon Blue Cross Blue Shield’s new DAW system edits, please CLICK HERE.

If you have any additional questions regarding the information within this eCommunication, please call Corporate Synergies at 1.866.CSG.1719 or CLICK HERE to contact us today.

Corporate Synergies is pleased to provide regular updates on issues affecting group benefits insurance. As an insurance broker and consultant, Corporate Synergies monitors federal and state legislative and regulatory activity to ensure that you stay informed.