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Under a new add-on program, plan members will have access to an expanded list of FDA-approved specialty generic medications with no copays.
Elixir, a pharmacy services provider that is a subsidiary of Rite Aid, has launched a specialty generic medication enhancement to its managed copay solutions effective June 1, 2022. The new add-on program allows members to receive generic versions of certain specialty medications at a $0 copay with no extra charge to the plan.
Elixir executives wanted to create a seamless program for generic specialty drugs with ease of use for the member. The new program is available to those in commercial lines of business. Those in Medicare/Medicaid programs, as well as those in high-deductible HSA plans, are not eligible, said Marly Arbuckle, RPh, CSP, senior director, specialty solutions and strategy for Elixir.
“We decided to do this for positive member experience,” she said recently in an interview with Formulary Watch. “We decided to add on a feature to an existing program and make for a seamless execution with no additional charge.”
The program includes 28 generic medications for complex medical conditions that are high-dollar and high-touch, she said. This includes medications for oncology, multiple sclerosis, neurologic and respiratory conditions. This list is updated bi-annually. (See table below for a list of included medications.)
Elixir leaders wanted to call attention to the generics available for these conditions. “We have generics in the marketplace that are widely accepted in the traditional drug space.” Arbuckle said. “But with more complex disease states comes more complex drugs and a more complex acceptance of generics. Unfortunately, there is a perceived lack of efficacy in the marketplace when it comes to generics for specialty diseases.”
Elixir has identified this lack of acceptance as a barrier for using specialty generics. “Members have brand loyalty and there’s this fear of switching. And there is uncertainty. We’ve experienced that firsthand over the last couple of years with a pandemic; we fear what we don’t understand.”
The products chosen for the program, she said, had to make sense from a financial standpoint for the plan and ensuring the drugs on the list are the most cost-effective option. “It doesn’t make sense to include single-source generic products in a program like this. There is no cost advantage. We’ve included multisource products when there’s no longer a rebate factor or compliance issues to consider.”