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Lower cost combination inhalers can save members money
March 8, 2019

This article is for allergists, nurse practitioners, physician assistants, primary care providers, pediatricians, and pulmonologists. Please also share with case managers and pharmacists associated with your practice.

The cost of a medication can impact a member’s adherence when filling their prescriptions.

Which members use the Blue Cross standard formulary?
  • Commercial medical plan members with our pharmacy benefits
  • Medex®´ members who have a three-tier pharmacy benefit

When prescribing combination inhalers for members who use our standard formulary, please consider equally effective options on our formulary that are available at a lower cost (lower tier), if clinically appropriate.

Our members can also save money when they use the Express Scripts PharmacySM (mail order) for a 90-day supply of their medication.

Preferred combination inhalers on our covered list of medications (formulary)

Please consider prescribing one of these tier 2* inhalers Instead of these higher-cost inhalers
  • Dulera
    (mometasone furoate/formoterol fumarate)
  • Generic Advair Diskus
    (fluticasone/salmeterol)
  • Generic AirDuo
    (fluticasone/salmeterol inhaler)
  • Symbicort
    (budesonide/formoterol fumarate)

Note: These inhalers are subject to step therapy criteria.

  • Advair Diskus
  • Advair HFA inhaler
  • AirDuo Respiclick
  • Breo Ellipta inhaler

*For members with a three-tier pharmacy benefit, this inhaler is available at tier 2 on our standard formulary.

Costs and coverage
To learn more about lower-cost options and our inhaler step therapy criteria, read our Inhaled corticosteroid and long- acting beta agonist inhalers drug cost alert fact sheet.

Inhaler adherence information is coming later this year
Medication management for people with asthma is a Healthcare Effectiveness Data and Information Set measure (a widely used set of performance measures developed and maintained by the National Committee for Quality Assurance).

Blue Cross reviews pharmacy claims to see if members were dispensed an appropriate controller medication and if they filled prescriptions for their controller. Later this year, we’ll be reaching out to notify you of patients who may not be using their controller medication regularly, based on our claims data.

Questions?
Call Angela Burnham, PharmD, Pharmacy Provider Partnership Manager, at 1-617-246-2448.

MPC_012519-3I-4-ART

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