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Pharmacy Utilization Management
Step Therapy
Generics Preferred
Generics Preferred with
PhysicianChoice
Members must try first line,
clinically effective, lower-cost
medications before they can
obtain a higher cost medication.
If a member receives a brand
name medication when a
generic is available, the member
pays the copayment plus the
difference in cost.
If the physician writes the script
for brand name, the member will
not pay the difference in cost.
Standard Blue KC Program
Available Option
Available Option
Medium Disruption
Medium Disruption
Medium Disruption
Home Delivery Programs
My RX Choices
HD Active Choice
HD Incentive Choice
Exclusive Home
Delivery
Targeted educational
communication to
promote the use of
home delivery and
Accredo Specialty
pharmacy.
Members must notify
ESI on their choice on
maintenance meds:
retail or mail. No
penalty to remain at
retail as long as the
member notifies ESI by
the deadline.
Plan design encourages
members to use home
delivery for
maintenance meds.
After 2 refills, the retail
copayment increases.
Maintenance meds
must be filled at home
delivery. Not covered at
retail after two refills.
Standard Blue KC
Program
Available Option
Available Option
Available Option
No Disruption
Medium Disruption
Medium Disruption
High Disruption
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