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WellPoint Unit Develops 4-Tier Drug Benefits Strategy

By Staff Writer

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NU Online News Service, April 21, 2004, 4:22 p.m. EDT – A unit of WellPoint Health Networks Inc., Thousand Oaks, Calif., has introduced a new prescription drug benefit management strategy for employers with more than 50 employees.[@@]

Instead of reviewing drug purchases ahead of time or drawing up a preferred drug list, the UniCare unit has established a 4-tier coverage system. Managers of the new YourChoiceRx program will start by looking at the average price, or reference price, of drugs within specific therapeutic categories. Some of the categories might include diabetes drugs and blood pressure drugs.

Managers will use the reference price for each category to sort drugs into the 4 coverage tiers:

- Level 1: Generic drugs that cost less than the reference price.

- Level 2: Brand name drugs that cost less than the reference price.

- Level 3: Generic or brand name drugs that cost more than the reference price.

- Level 4: Self-injectable drugs.

Plan members will be responsible for talking to doctors to see whether they can use Level 1 drugs or must use drugs in higher tiers, UniCare says.

UniCare is a WellPoint unit that sells health insurance throughout the United States. It provides coverage for 1.7 million U.S. residents.