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2017 BlueKC Approved Key Recommendations -
Savings Opportunities
Estimated Plan Cost
PMPM Savings
Description
Estimated
PMPM Savings
on Blue KC
BOB
Disruption
Time to
Implement
Clinical Program
Options
Generics Preferred
If a member receives a brand-name drug when a
generic is available, they will pay the generic copay plus
the difference in the allowable cost of the generic and
the brand-name drug.
$1.77 PMPM
Medium
120 days
Physicians Choice - Generics
Preferred
If the physician (DAW2) chooses the brand-name drug,
the member will not pay the copay plus the difference
in the cost of the generic and the brand-name drug.
$0.89 PMPM
Medium
120 days
Removal of Grandfathering (GF)
At a group’s renewal, when Grandfathering is removed,
a member must now try a front-line (sometimes
generic) drug first before a less-preferred, higher cost
drug (usually brand) is prescribed.
$1.31 PMPM
Medium
120 days
47