888-765-5400Medication Dedication
Approximately 50 percent of people who suffer from chronic health conditions do not take their medications 
as directed. 1 Studies show that failure to take medications as prescribed results in the loss of approximately 125,000 lives a year from cardiovascular disease alone. 2
Medication DedicationSM, a new program from Blue Cross and Blue Shield of North Carolina (BCBSNC), is designed to help members with specific chronic conditions avoid the risks involved with not taking their medications as prescribed by removing cost barriers often associated with prescription medications.
Q: What is Medication Dedication?
It’s a new medication adherence program from Blue Cross and Blue Shield of North Carolina (BCBSNC) designed to help members with specific chronic conditions take their medications as prescribed by their health care provider. Since cost can be a significant barrier to taking medications as directed, BCBSNC is waiving the copayment for generic medications that treat the following conditions: congestive heart failure, high blood pressure, high cholesterol and diabetes. BCBSNC is also moving certain brand-name drugs that treat those same conditions to a lower drug level tier to make them more affordable.
Q: Why is Medication Dedication important?
The connection between increased medication adherence, improved health and lower health care costs has been proven repeatedly. Yet many people do not realize how important taking their medications as prescribed is to the management of their condition. Rates of non-adherence to medication treatments are estimated to be as high as 50 percent. 1 Studies show that failure to take medications as directed results in the loss of approximately 125,000 lives a year from cardiovascular disease alone. 2 Members with specific chronic conditions who do not take their medications as prescribed may render their treatment ineffective and potentially endanger their health.
Q: Are all BCBSNC members eligible for Medication Dedication?
Only members who fill prescriptions for congestive heart failure, high blood pressure, high cholesterol and diabetes are eligible to receive the drug tier cost changes. The generic copayment waiver is available only to members of fully-insured groups and self-funded (ASO) groups that have opted-in to this part of the program. Members of the State Health Plan and Federal Employee Program are not eligible for the Medication Dedication program because BCBSNC does not administer pharmacy benefits for those plans. Medicare Part D members are also not eligible.
Q: I am part of a self-insured (or ASO) employer group. Am I eligible for this program?
BCBSNC is making the Medication Dedication copayment waiver available to members of its self-insured groups that have pharmacy benefits through BCBSNC on an opt-in basis. Check with your group benefits manager to see if your group has elected to take this part of the program.
Q: How can I apply for Medication Dedication?
No application is necessary. You only need to take your prescription and BCBSNC ID card to a participating pharmacy. The copayment waiver is applied automatically when you fill a prescription for a generic drug that treats any of the specific chronic conditions covered under Medication Dedication. If the prescription is for a brand-name drug that has been moved to the lower drug tier, the cost savings will be applied automatically at the pharmacy as well.
Q: How long will Medication Dedication run?
The program begins January 1, 2008, and is expected to run through 2009.
Q: Why is BCBSNC waiving the copayment for generic drugs for specific conditions?
BCBSNC wants to make it easier for members with specific chronic conditions to stay on their medications as prescribed by making those medications more affordable. We believe Medication Dedication can help keep our members healthy while reducing overall medical costs.
Q: I don’t have a copayment, but I have a coinsurance amount that I pay for prescription drugs. Will my coinsurance be waived?
If your pharmacy benefit has a coinsurance benefit instead of a copayment, it will be waived.
Q: Will my deductible amount be waived?
Only coinsurance amounts and copayment amounts will be waived. You must meet your deductible before becoming eligible for copayment and/or coinsurance waivers.
Q: Which generic drugs are eligible under Medication Dedication?
Any FDA-approved generic drugs that treat congestive heart failure, high blood pressure, high cholesterol and diabetes (both new prescriptions and refills that are filled beginning January 1, 2008) are eligible for the copayment waiver. For a complete list of the generic drugs covered under Medication Dedication, view the complete Copayment Waiver Drug List (.pdf 30 KB).
Q: Are generic drug refills included in Medication Dedication?
Yes. The waiver applies to both refill prescriptions and new generic prescriptions that are filled beginning January 1, 2008.
Q: If I had a generic prescription filled before January 1, 2008, can they have that copayment waived?
No. The program applies only to generic prescriptions filled on or after January 1, 2008.
Q: Which brand-name drugs are moving to the lower drug tier?
Tier 3 brand name medications that do not have a generic equivalent and are used to treat congestive heart failure, high blood pressure, high cholesterol and diabetes will be moved to Tier 2 on the formulary. 3 For a complete list of the drugs moving to Tier 2, view the complete Formulary Change Drug List (.pdf 22 KB).
Q: Will BCBSNC expand Medication Dedication to include other conditions?
While there are no current plans to expand at this time, Medication Dedication may include additional chronic conditions after the program has been fully implemented and evaluated.
Q: Why target specific conditions with Medication Dedication?
These particular conditions have been identified as focus areas for BCBSNC, based on their prevalence and overall impact to medical costs. Research focused on these conditions have shown that improved health is possible with increased medication adherence. 4
Q: What is a generic drug?
A generic drug is the same as its corresponding brand-name version when it comes to active ingredients, dosage, strength, safety and performance, yet it typically costs up to 80 percent less. 5 A generic drug usually becomes available after the patent for the brand-name version expires.
Q: What’s the difference between a brand-name drug and a generic drug?
According to the FDA, generic drugs are the same as their brand-name counterparts in active ingredients, dosage, safety, strength and performance. 6 The only noticeable differences in generics and brand-name medications may be the shape or color of the drug. Plus, generics can cost up to 80 percent less than brand-name drugs.
Q: Are generic drugs less safe than brand-name drugs?
Generic drugs are FDA-approved and meet the same standards of safety and effectiveness as brand-name drugs. Generics have the same active ingredients, dosage, strength and performance as their corresponding brand-name versions.
Q: How can I know if my drug is a generic drug?
Your health care provider or pharmacist can tell you whether the drug you are taking is brand name or generic. You can also use Find drug info to learn whether a prescription drug is brand-name or generic.
Q: What if I don’t want to take a generic drug?
BCBSNC members are free to use brand-name medications, even if a generic equivalent is available. But since members typically pay more out-of-pocket for brand-name drugs, it may make medication adherence more difficult.
Q: I am taking a brand-name drug that does not have a generic equivalent. Will BCBSNC waive my brand-name drug copayment since there is no generic equivalent?
No. The purpose of Medication Dedication is to improve medication adherence by encouraging members and physicians to consider generic alternatives when they are available and appropriate, and to help make drug costs more affordable. BCBSNC is also placing brand-name drugs that treat specific chronic conditions into a lower copayment tier to make them more affordable to members.
Q: Will I still be able to get my brand-name prescription filled even if a comparable generic version is available?
Yes. BCBSNC covers virtually all FDA-approved drugs. However, we encourage you to consider generic drugs, when appropriate, in consultation with their health care provider.
Q: Will generic drug copayments be waived if I purchase drugs through a mail order program, instead of a local pharmacy?
Yes. BCBSNC’s pharmacy claims system is configured to automatically waive any copayment amount on a generic drug under Medication Dedication, whether filled through mail order or at a retail pharmacy.
Q: Does the generic drug copayment waiver apply both to refills and new prescriptions filled through a mail order program?
Yes. For refills and new prescriptions, the member’s copayment amount for an applicable generic drug will be waived in either situation.
Q: How does this generic drug copayment waiver apply when ordering a 90-day supply through mail order?
If members call to fill their generic prescriptions for a 90-day supply on or after January 1, 2008, their 90-day copayment amount will be waived. Please note, however, that benefit rules still apply. This means that members may only receive a 90-day supply of drugs in a 90-day period.
Q: How long will I be able to receive a copayment waiver for mail order prescriptions?
As long as Medication Dedication is in effect. For example, if a 90-day mail order drug request is submitted between January 1, 2008 and December 31, 2008, the member will have the 90-day copayment waived.
Q: Will I automatically receive a generic drug if I order a brand-name drug through mail order?
If the prescription allows for a generic substitution, then typically the mail order pharmacy will dispense a generic version. However, to ensure that members get the full benefit of the waiver, they should have their physician indicate on the prescription that a generic substitution is permitted.
For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.