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.