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Blue Shield proposes four-tier drug formulary; board asks for member-impact and retroactive cost analysis
Summary
Blue Shield told the Health Service Board it plans to reorganize its drug formulary into four tiers in 2019, moving some high-cost generic drugs to higher tiers and estimating about $360,000 in savings; commissioners and public commenters asked for a clearer list of affected drugs, utilization details and a retroactive cost-impact analysis for members.
Blue Shield of California presented a proposed redesign of its outpatient drug formulary that would group medications into four tiers for the 2019 plan year and move certain higher-cost generics into higher-cost tiers.
Neil Higashida, Senior Manager of Pharmacy Services at Blue Shield, said the intent is to manage rapidly rising drug costs by aligning drug placement with clinical value and cost-effectiveness. "The new formulary tier structure will be named tiers 1 through 4," he said, explaining that tier 3 would include more…
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