New York Health Plans Making Significant Changes to Pharmacy Benefits Design

Prescription Drug Plan Market Also Sees Health Plan and Pharmacy Alignment, According to the TriState Health Plan Analysis Now Available from HealthLeaders-InterStudy

NASHVILLE, Tenn.--(BUSINESS WIRE)-- HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that health plans in New York are making significant changes to their pharmacy benefits designs. Empire BlueCross and BlueShield and Capital District Physicians’ Health Plan (CDPHP) are making changes to their pharmacy benefit design according to, the TriState Health Plan Analysis.

Empire is modifying all of its small-group plans to have coinsurance for non-formulary drugs instead of a copay, while CDPHP is making more than 200 generic drugs available for as low as $1 if purchased at a CVS, Walmart, or Price Chopper drug store, according to the report.

Empire’s small-group plan members are now paying a co-insurance range from 35 to 50 percent for many branded drugs.

“Empire’s move is largely in reaction to the increased use of drug discounts or coupons offered by pharmaceutical marketers to insured members to counter rising copays for branded drugs,” says Chris Lewis, market analyst with HealthLeaders-InterStudy.

Some questions answered in the recent TriState Health Plan Analysis include:

  • What does CEO Mark Wagar have to say about the reasons behind Empire’s drastic product streamlining?
  • How will Anthem Blue Cross and Blue Shield in Connecticut reward people who choose low-cost providers in its new SmartShopper program?
  • Did the Connecticut Joint Replacement Institute develop its episode-based payment program?

You can view an abstract of the report here.

For more information about the Empire BlueCross BlueShield small-group plan changes please download a copy of our latest Executive Briefing: Is Insurance Strife In NYC A Sign Of Reform Future?

You can download a copy here.

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Kristi Guillemette, 781-993-2618
[email protected]
Decision Resources Group
Elizabeth Marshall, 781-993-2563
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KEYWORDS:   United States  North America  Tennessee

INDUSTRY KEYWORDS:   Practice Management  Health  Pharmaceutical  Professional Services  Insurance  General Health  Managed Care