Watch your meds…

Got an interesting flyer from Humana today. Effective May 1, they’re changing how they cover certain medications. Based on previous experience, I expect other carriers to follow suit shortly.

The letter starts out auspiciously enough:

“Humana is launching a new program designed to help employees who take certain high-cost drugs save money each month on their prescriptions. And when employees choose less expensive drugs, overall pharmacy costs should decrease.”

The program targets specific medications that have “lower-cost alternatives,” presumably generic equivalents. For now, Humana is focusing on meds for heartburn, pain, allergy and high cholesterol. Left unsaid, but certainly easily inferred, look for blood pressure and anti-depressant meds to follow.

The program is set up so that, at the next refill (or, for first-time use, the initial scrip), insured’s will need to talk with their doc about their new options:

- Switch to lower-cost alternative (i.e. generic),

- Stay on current med, but absorb a greater share of the cost, or

- Obtain authorization to continue with their current prescription

This is really not all that new, and I’m not convinced that it’s necessarily a bad idea. In recent years, a disproportionate percentage of health costs – and renewal increases --has been attributable to meds. And many carriers have implemented a “formulary-based” protocol; that is, if you’re med isn’t on their “preferred” list, you pay more (sometimes a LOT more) for it.

This move is also consistent with Humana’s increasing push for Consumer Driven Health Care. The idea is that patients should be taking a more pro-active role in their own care. We see this in the widespread publicity (if not actual purchase) of High Deductible Health Plans and HSA’s, and the disappearance of the lower end of the deductible scale (when was the last time you saw a $250 deductible?).

I actually applaud this move, because it encourages us to take a more active role in our care, and in how we access and use the healthcare system. The funny thing is, I don’t currently have any groups with Humana (that’s another post), but I think that this move is a positive step in the evolution of how we pay for healthcare.