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Brand Name vs. Generic Drugs
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What you
don’t know
can cost
you
Spring 2003
What you
don’t know
can cost
you
What you
don’t know
can cost
you
Spring 2003
~ sign up On-Line to win $50 gift card — P. 15 ~~ Sign up On-Line to win $50 gift card — P. 15 ~
Brand Name
or Generic?
Brand Name
or Generic?
Brand Name
or Generic?
from the files from the filesHEALTH
n e w s s t o r i e s f r o m a c r o s s t h e c o u n t r y
Generic drug use reaches all-time high in 2002The Washington Post recently reported that
generic drug usage in the United States reachedan “all-time high” in 2002.
Express Scripts, a pharmacy benefits man-ager based in St. Louis, found that 45.2 per-cent of prescriptions filled were from genericdrugs, an increase of 5 percent from the pre-vious year. The shift toward greater genericdrug usage was fueled by generic versions ofpopular brand-name drugs entering the mar-ket, as well as the health insurance industry’sefforts to control rising health care costs, ac-cording to The Washington Post.
The Post cited that the biggest reason forthe jump was because patients now were ableto purchase generic versions of three popularmedications: Prozac (anti-depressant),Glucophage (for treatment of diabetes) andZestric (for high blood pressure).
Need help finding the best deals onprescription drugs?
According to a recent article in The WallStreet Journal, the National Council on Aginghas launched a new service to help senior citi-zens search for programs that provide the bestbang for their buck when it comes to prescrip-tion drugs.
The new service, which can be accessed atwww.benefitscheckup.org, is designed to reachmillions of seniors in the United States whomay be eligible for public or private assistance,but who are not receiving it at this time. Se-
niors with Medicare,who do not have pre-scription drug benefitsand have an income
under $28,000for one personor $38,000 as acouple, will beable to find pro-grams to savethem money.
According to The Wall Street Journal, theWeb site also is designed to help younger peopleand, in come cases, Americans with higherincomes, through searches of 116 patient-as-sistance programs sponsored by pharmaceu-tical companies.
FDA drug application review time increasedin 2002
According to an article in The Wall StreetJournal, the Food and Drug Administration’s(FDA) approval time for drug applications in-creased slightly last year, a trend that repre-sents a contrast from previous years. In 2002,the median approval time for standard drugapplications was 15.3 months, an increasefrom 14 months in 2001 and 12 months in2000, according to the newspaper. The in-creased approval time is an effort by the FDAto investigate new drugs more thoroughly.
Survey shows patients often get requested drugsPreliminary results of a new survey show
that most of the time when patients request amedication, physicians write prescriptions forthat drug, according to news reports. The Foodand Drug Administration (FDA) survey alsoshowed that half the time in those situations,patients requested a drug after seeing it ad-vertised, The Washington Post reported. USAToday reported that 40 percent of doctors saidpharmaceutical companies’ direct-to-consumer(DTC) advertising has a somewhat or verypositive effect on their practices; 32 percentsaid the effect was somewhat or very nega-tive; and 28 percent said the DTC ads had noeffect at all.
3
is published four times a year byArkansas Blue Cross and Blue Shieldfor the company’s members, healthcare professionals and otherpersons interested in health careand wellness.
Vice President of Advertising and Communications:Patrick O’Sullivan
Editor: Kelly Whitehorn — [email protected]
Designer: Gio Bruno
Contributors: Tammi Bradley, Janice Drennan, Damona Fisherand Kathy Luzietti
Customer Service Numbers
Little Rock Toll-freeCategory Number (501) Number
State/Public School Employees 378-2437 1-800-482-8416
e-mail: [email protected] [email protected]
Medi-Pak (Medicare supplement) 378-3062 1-800-338-2312
Medicare (for beneficiaries only): Part A (hospital benefits) 378-3151 1-877-356-2368 Part B (physician benefits) 378-2320 1-800-482-5525
UniqueCare, UniqueCare Blue, Blue Select®, BlueCare PPO & PPO Plus (individual products) 378-2010 1-800-238-8379
Group Services 378-2070 1-800-421-1112
BlueCard® 378-2127 1-800-880-0918
Federal Employee Program (FEP) 378-2531 1-800-482-6655
Health Advantage 221-3733 1-800-843-1329
BlueAdvantage Administrators 378-3600 1-800-522-9878
Pharmacy Customer Service (AdvancePCS): Arkansas Blue Cross and Blue Shield 1-800-863-5561 Health Advantage 1-800-863-5567 BlueAdvantage Administrators 1-888-293-3748 Specialty Rx 1-866-295-2779
For information about obtaining coverage, call:Little Rock Toll-free
Category Number (501) Number
Medi-Pak (Medicare supplement) 378-2937 1-800-392-2583
BasicBlue®, BlueCare PPO & PPO Plus (individual products) 378-2937 1-800-392-2583
Regional Office locations are: Central, Little Rock;Northeast, Jonesboro; Northwest, Fayetteville; South Central,Hot Springs; Southeast, Pine Bluff; Southwest, Texarkana;and West Central, Fort Smith.
Customers who live in these regions may contact the regionaloffices or call the appropriate toll-free telephone numbers above.
Web sites: www.ArkansasBlueCross.com,www.HealthAdvantage-hmo.com,
www.BlueAdvantageArkansas.com,www.BlueAndYouFoundationArkansas.org
www.BlueAnnEwe-ark.com
INSIDETHIS ISSUE
~Spring 2003~
From the Health files ................................... 2High standards for generic drugs ................. 4Q & A on generic drugs ................................ 5The cost of new drugs ................................. 6New generic drugs on the way ..................... 7On-line resources for health & drug info ..... 7The rising cost of prescription drugs ........... 8Helping to control drug costs ...................... 9Storing and handling your medications ....... 9Generic drugs for many illnesses.......... 10-11Over-the-counter painkillers ...................... 12New pharmacy Web site ............................. 13How to use My Blueprint ....................... 14-15Protection of your health information .. 16-18The pharmacist is in .................................. 19A leader in Web site performance.............. 19Fayetteville office sponsors seminars ....... 20Joining with Cardiovascular Task Force .... 21Health Advantage pleases doctors ............ 21Readership/Internet survey results ............ 22“Wellness” contest winners announced .... 22High School Heroes .................................... 23Blue & Your Community ............................. 24
4According to the Congressional Budget
Office, generic drugs save consumers an esti-mated $8 to $10 billion per year when comparedwith the price of brand-name products. Equallyas important as the cost-effectiveness of genericdrugs is that they are reviewed by the U.S. Foodand Drug Administration (FDA) to ensure thatthey provide the same level of benefit to patientsas their brand-name counterparts. The FDA hasapproved approximately 7,000 generic drugs forvarious treatments.
The basic requirements for approval ofgeneric and brand-name drugs are the same. The
only difference is that genericdrug makers do not have torepeat the safety and efficacystudies conducted by thedeveloper of the originalproduct. In approving a genericdrug, the FDA relies on itsprevious finding that theoriginal drug is safe and effec-tive. The generic version musthave the same dosage form,safety, strength, route ofadministration, and conditions
of use as the brand-name product. The genericdrug’s manufacturer also must show that the
active ingredient of the generic drug isabsorbed at a rate and extent similar to itsbrand-name counterpart.
With the exception of language pro-tected by patents or exclusivity, the labelingof the generic drug, including directions foruse, must be virtually the same as that of thebrand-name product. Both generic andbrand-name drug makers must submit
information to show the approved products arebeing manufactured to the FDA’s specifications.
The FDA regularly assesses the quality ofgeneric medications and reports on theirperformance. A recent FDA review foundthat the average difference between thebioequivalence of more than 270 generic
drugs approved in 1997 and their brand-name counterparts was 3.5 percent. This is
Generic drugs must meet HIGH standards
about the same as the differences found betweenseparate batches of brand-name products.
The Drug Price Competition and Patent TermRestoration Act of 1984 encourages the produc-tion of generic medicines while protecting therights of brand-name manufacturers. The lawbuilds in certain protections for the original drugdeveloper in terms of patents and marketexclusivities, but it also allows sponsors ofidentical products to apply for their approval bythe FDA without repeating the originaldeveloper’s clinical trials. In addition, the lawrewards exclusivity for a first generic version of abrand-name drug, thereby encouraging genericfirms to challenge innovator patents.
— Source: U.S. Food and Drug Administration
The generic version must have thesame dosage form, safety, strength,
route of administration, andconditions of use as the
brand-name product.
5Q. Are generic drugs really the same as brand-name drugs, or are they inferior imitations?A. All drug makers must adhere to strict manufacturing requirements from the U.S. Food and Drug Administration (FDA)
to earn approval to sell their products. FDA regulations require that generic medications be made with the samestandards of purity, stability, strength and quality as their brand-name equivalent. A generic drug must demonstratethe same bioequivalence as its brand-name counterpart.
Q. What are the differences between generic and brand-name drugs?A. There are two main differences between generic and brand-name drugs. The first difference is the
name. The brand name is the name under which the product is sold and is protected by apatent for up to 20 years. For example, the company that developed acetaminophen gave itthe brand name, Tylenol. When the patent expired, other companies began producing thesame product and selling it under its generic name, acetaminophen. In many cases, the samecompany that manufactures the brand also produces a generic version. The other difference betweengeneric and brand-name drugs is that generic drugs are not advertised. The lack of advertisinghelps keep costs down — think of generic drugs as the unadvertised brands.
Q. What is a “patent” and how does it work?A. A patent protects and establishes a company’s right to produce and control a product exclusively. The patent
prevents other companies from making and selling the product during the patent period. Drug patents can last up to20 years. The patent is given because the original manufacturer has spent time and money researching and develop-ing the drug.
Q. If both generic and brand-name drugs have the same ingredients, why do they look different from each other?A. Generic drug makers are required by law to make their drugs look different from the brand-name products so consum-
ers can tell them apart. This means the generic usually is a different shape and color than the brand-name drug.
Q. Why do generic drugs cost less than brand-name drugs?A. Generic drugs cost less because the generic drug makers did not incur the same research, development, sales and
marketing costs as the brand-name drug manufacturer. These savings are reflected in lower prices, which are passedon to the consumer.
Q. Why should I care what a drug costs? I have health insurance.A. Everyone pays for higher drug costs in the form of increasing copayments or health insurance premiums. The choices
that you make today will impact your premiums in the future. By asking for the generic version when you get yourprescription, it will save you money directly. Many times generic drugs have a lower copayment or coinsurance costthan brand-name drugs. When you ask for a generic drug, you save money without sacrificing quality.
Q. Does every brand-name drug have a generic alternative?A. No. If a drug still is protected by a patent, it can only be supplied as a brand-name product by one company. When
the patent expires, other companies may apply to the FDA to produce a generic version of the drug. Additionally, theoriginal manufacturer usually will continue to make the brand-name product and a generic version, often using thesame or side-by-side assembly lines.
Q. Why doesn’t my doctor automatically prescribe generic drugs?A. In some cases, generics are overlooked because of direct-to-consumer drug advertising, which
promotes brand-name drugs and makes them the first choice for many physicians. Generic drugsare not advertised so people don’t know how to ask for them by name. Another reason yourdoctor may prescribe a brand-name drug is that there may not be a generic equivalent available.Depending on certain circumstances, the brand-name medication may be the most appropriatemedication for you. It’s important to talk to your doctor about generics if you currently are usingbrand-name drugs.
Questions and Answerson generic drugs
Questions and Answerson generic drugs
6Newer medications cost more than the drugs they
are replacing. While many of these new drugs may belife-saving medications, critics of the pharmaceuticalindustry say that most brand-name products are notbreakthrough drugs. In fact, most drugs approved by theU.S. Food and Drug Administration (FDA) are variationsof products already on the market.
During the 1990s, brand-name drug makers intro-duced more than 300 new products to the market, andthe FDA approved them quickly.However, faster isn’t always better.Several new drugs had to be pulledoff the market after causing serious,and in some cases deadly, prob-lems, and the FDA now appearsmore cautious about approving newdrugs for consumers. Drugs ap-proved more recently may be morelikely to have unrecognized adversereactions than established drugs,according to a 2002 study publishedin the Journal of the AmericanMedical Association.
Thirty-five million Americans —1 in 8 — are age 65 or older, accordingto the Census Bureau. The number ofelderly people is expected to swell to82 million — 1 in 5 — by 2050. Today’ssenior population includes 1.6 million people who areage 90 or older. As consumers age, they begin to encoun-ter more serious health conditions (such as arthritis, highblood pressure and diabetes) that require medication.They also begin to look to drugs to address such issuesas hair loss and impotence.
Drug manufacturers go to great lengths to generatedemand for their drugs, especially the best sellers, whichare usually the most expensive medications in theircategories. Drug companies send their sales representa-tives to doctors’ offices with samples, gifts, catered
lunches and more. In recent years, theyalso have increased their “direct-to-
consumer” advertising with print adand television commercials. Theseads encourage consumers to “asktheir doctor” if a certain drug isright for them.
Drug companies spent $2.5
billion on direct-to-consumer ads in 2000, and morethan 30 times what they spent on mass media ads in1991, according to the National Institute for Health CareManagement. The ad spending exploded, accordingto the Institute, because drug companies realized itincreased sales.
One of the most heavily advertised drugs is Vioxx,the best-selling anti-arthritic pain reliever. The manufac-
turer of Vioxx spent $160 million ondirect-to-consumer ads in 2000,exceeding ad budgets for Pepsi($125 million) and Nike ($78million).
According to the EmployeeBenefit Research Institute, drugspending has jumped 92 percentnationally in the past five years.Just think how much a gallonof milk or a new car would costif the price rose 92 percent infive years!
In the past, most prescrip-tion drug costs have been paidby health insurance companiesand employers. But, as thecosts continue to escalate,
employers are expecting employ-ees to carry some of the burden. As a result, more
employees are paying more of the cost of these drugsthrough higher deductibles and copayments. For years,insurance companies charged a flat copayment for eachprescription filled. Now, many plans offer a three-tierformulary copayment plan.
The Arkansas Blue Cross and Blue Shield Three-TierMedications Formulary is a list of FDA-approved medica-tions selected by a committee of practicing physiciansand pharmacists. Formularies have been used in hospi-tals for many years to help ensure that drugs are dis-pensed in a cost-effective and proper manner. Exclusionswill vary depending upon your group benefits. Theformularies are revised periodically to reflect changingdrug therapies. (See related formulary article on page 9.)
After all is said and done, there’s no drug availablewithout a price in both dollars and side effects. If youmaintain healthy skepticism about drug ads, and askyour doctor good questions, you’ll do well in this worldof direct-to-consumer advertising.
Pill-packagingand
advertising:
Pill-packagingand
advertising:understanding the cost of new drugsunderstanding the cost of new drugs
7Some significant brand-name drugs lost (or are
scheduled to lose) their patents in 2002 and 2003. Thiswill open the door for generic drug launches of thesame medications.
Drugs with significant potential to see their firstgeneric equivalents hit the market are:Ortho-Novum 7/7/7* (birth control)Ortho Tri-Clyclen* (birth control)Accupril (blood pressure)Nolvadex (breast cancer)Topamax (anti-convulsant)Glucophage XR (diabetes)Monopril (blood pressure)Remeron (anti-depressant)Alphagan (glaucoma)Serzone (anti-depressant)Glucovance (diabetes)Glucotrol XL (diabetes)Wellbutrin SR (anti-depressant)Zyban (smoking cessation)Neurontin (anti-convulsant)
Tiazac (blood pressure)Cipro* (antibiotic)
* Indicates approval, but has not been marketed as a generic drug as patent issues remain.
Special Note:This list is a good-faith effort to provide useful
information on innovative drug products that facepotential competition from a generic equivalent.
Many of the drugs listed are associated with activepatents that have been challenged. Resolution of
these patent challenges in favor of the genericdrug maker likely will determine if a generic
can be approved in the year noted. Forthis reason, some of the drugs listed
likely will not face generic competi-tion as shown. The expiration of
the pediatric exclusivity has beenconsidered for some of the
listed drugs. The list is notstatic and is constantly
updated.
• Centers for Disease Control and Prevention, www.cdc.gov• National Institutes of Health, www.nih.gov• American Medical Association, www.ama-assn.org• American Cancer Society, www.cancer.org• American Heart Association, www.amhrt.org• American Diabetes Association, www.diabetes.org• National Drug Information and Referral, www.health.org• National Center for Complementary & Alternative Medicine, www.nccam.nih.gov• Asthma and Allergy Foundation of America, www.aafa.org• The Blue Cross Blue Shield Association, www.bcbshealthissues.com/cost• Blue Cross Blue Shield of Michigan, www.theunadvertisedbrand.com• Arkansas Blue Cross and Blue Shield, www.ArkansasBlueCross.com/members/cost_video.asp• National Institute for Health Care Management, www.nihcm.org
On-line resources for health and prescription drug information
New generic drugs on the way ?New generic drugs on the way ?
8During the past five years, spending on prescription
drugs by Arkansas Blue Cross and Blue Shield for itsmembers has increased approximately 18 percent eachyear; that’s a 90 percent increase in spending on pre-scription drugs. In the next five years, it probably willincrease by another 18 percent or more each year.
Compare that to the 5.25 percent-per-year increase inspending on medical services for members by ArkansasBlue Cross during the past five years. That amounts to anincrease of 26 percent in spending on medical services(including physician fees, outpatient and inpatient costs)during the past five years. Spending on prescriptiondrugs increased at a rate of more than three times whencompared to spending on medical services.
Is there any way to decrease the spending on pre-scription drugs? Actually, there is. When consumers areprescribed or request generic drugs, everyone saves
money. For example, in Arkansas in 2001,the average cost of a brand-name drugwas $66 while the average cost of ageneric drug was $18. In 2002, theaverage cost of a brand-name drugincreased to $72 while the average costof a generic drug actually decreasedto $16.50.
Below are the brand-name drugswith a generic equivalent that wereoften prescribed (and were the mostcostly) for Arkansas Blue Cross and
Health Advantage members during 2002.Note the difference in cost when thegeneric is compared to its brand-name
counterpart. All costs listed below for prescription drugsare the actual cost for Arkansas Blue Cross and HealthAdvantage; however, members pay the copayment asspecified by their benefit plans.
Other high-cost drugsoften prescribed formembers include Prevacidfor gastritis/esophagitiswith an average cost of$99; Celebrex, a painreliever with an averagecost of $67; Zocor, a cholesterol-lowering drugwith an average cost of $75; and Vioxx, a pain relieverwith an average cost of $52. These three drugs are all onthe third tier of the Arkansas Blue Cross MedicationsFormulary, meaning they have the highest copayment forour members, and there is no generic equivalent for thedrugs at this time. However, it’s possible there may be adrug on the second tier of the formulary that offers thesame effectiveness. The second-tier drugs are brand-name-preferred drugs that offer a mid-level copayment.If you are using a third-tier drug, you may want todiscuss with your physician other prescription optionsfor your treatment.
Here are some second-tier formulary drugs without ageneric equivalent at this time (mid-level copaymentprescriptions). Lipitor, a cholesterol-lowering drug withan average cost of $58; Zoloft, an anti-depressant with anaverage cost of $55; Protonix, a drug used for gastritis/esophagitis with an average cost of $75; Paxil, an anti-depressant with an average cost of $58; and Effexor XR,an anti-depressant with an average cost of $66. Thesedrugs often are prescribed for our members.
In some instances, there are no generics available forbrand-name prescription medications. However, youshould always discuss with your physician the bestcourse of action to take in your situation, whether thereis a generic drug available, or if there is a lower-cost drugavailable that is suitable for you as a treatment option.
Brand name Average Used to treat Generic Average cost equivalent cost
Prilosec $109 Gastritis, esophagitis Omeprazole In transitionProzac $125 Depression Fluoxetine $20Zestril $35 High blood pressure Lisinopril $16Vicodin ES $38 Pain Hydrocodone $14Zantac $60 Gastritis, esophagitis Ranitidine $19Minocin $65 Infection (antibiotic) Minocycline $22Darvon –100 $46 Pain Prepoxiphane napsalyte $20Zovirax $92 Virus (antiviral) Acyclovir $28Vasotec $60 High blood pressure Endapril $22
Drug costs continue to rise; no end in sight Prescription drug spending increased
90 percent between 1998 and 2002Prescription drug spending increased
90 percent between 1998 and 2002
Tips on storing and handling your prescribed medications
9Arkansas Blue Cross
and Blue Shield works tocontrol escalating drug
costs through itsPharmacy and Thera-peutics Committee,
whose decisions form thebasis of the Three-Tier Medications
Formulary. The committee, the majority of whosemembers are doctors and pharmacists from outside theorganization, makes recommendations regarding pre-ferred and non-preferred medications. Members can savethe most money by using generic drugs, which arealways on the first tier of the formulary, requiring thelowest copayment. Using brand-name preferred drugs(selected for their effectiveness, safety, uniqueness andcost-efficiency) also saves members money becausepreferred drugs are on the second tier and require a mid-level copayment. Non-preferred drugs (those consideredby the committee to fall short of other drugs in the same
What are we doing tohelp control drug costs?
therapeutic class in regard to effectiveness, safety,uniqueness or cost-efficiency) comprise the third tier andrequire the highest copayment.
How you can help control drug costs1. Ask if the medicine is available in a generic — you
could save as much as 75 percent.2. Ask if there’s a lower-priced alternative that will work
just as well.3. Understand how your prescription drug benefit works.4. For a new prescription, ask your physician for a starter
sample so you won’t be stuck with a costly drug thatmay not work for you.
5. Call around for the lowest price. Pharmacy prices vary.If you find it cheaper somewhere else, ask your regularpharmacist if he or she can match the price.
6. Ask for discounts that may be offered for seniors,infants, children and students.
7. Buy store-brand or discount-brand over-the-counterproducts. Ask your pharmacist for recommendations.
By storing your medications properly, youcan ensure their effectiveness and reduce potentialside effects.
Although many people usually store their drugs inthe bathroom, that’s probably not the best place. Mostdrugs are sensitive to heat andmoisture.Others may besensitive tolight. Exposureto either mayalter or damageyour drugs.
Store yourmedications in acool dry place outof direct sunlightand out of the reach of children and pets. Keep the capon the bottle, and if you notice any changes to your
Tips on storing and handling your prescribed medications
drugs (cracking or changes in color), contact yourpharmacist.
Throw away expired drugs. Do not keep expireddrugs “just in case” or because they were expensive.Some drugs lose their effectiveness, and some mayactually increase in strength, posing an overdose risk. Insome cases, you actually may forget what the drug wasprescribed for in the first place. It’s always better to justthrow expired drugs away.
When you are prescribed a drug by your doctor, takethe drug exactly as prescribed. If your doctor or pharma-cist tells you to take all of the medicine,don’t stop when the bottle is halfempty just because you feel better.Never take someone else’s drugs,and if you are unsure about how totake a prescribed drug, contactyour doctor or pharmacist for moredetailed instructions.
What are we doing tohelp control drug costs?
The
Three-Tier
Formulary
Be smart:10From high blood pressure to depression, there are
generic drugs to treat many illnesses. By using genericequivalents of brand-name drugs, everybody savesmoney. Many of our members use the generic equiva-lents to treat the following illnesses.
High Blood PressureBrand-name drugs: Zestril ($35) and Vasotec ($60)*Generic drugs: Lisinopril ($16) and Endapril ($22)*
You may have high blood pressure and not know it.Approximately 50 million Americans age 6 and older
have high bloodpressure. TheAmerican HeartAssociationstates that morethan 31 percentof people withhigh bloodpressure don’tknow theyhave it, andthat 26.2
percent of people with high blood pressure takemedication but do not have their high blood pressureunder control.
According to an article in the Journal of the Ameri-can Heart Association, a recent analysis predicts thatcurrent middle-aged Americans face a 90 percent chanceof developing high blood pressure during their lives. Italso stated that blood pressure control and cardiovascu-lar disease rates are improving among minority ethnicgroups in this country. However, rates are not improvingas much in majority populations.
Blood pressure is defined by two numbers. The firstnumber is called systolic pressure, and it measures thepressure in your arteries while your heart beats. Thesecond number is called diastolic pressure, and it mea-sures the pressure while your heart rests between beats.The two numbers should fall under 140/90 if you have
normal blood pressure. But, accordingto an article in the Journal of the
American Heart Association,current blood pressure goals aren’tlow enough for people with diabe-tes. The current goal is 140/90,
and it is suggested that the goal be
Be smart:130/85 forpeople withdiabetes.
You maynot even knowthe cause ofyour highblood pres-sure. In 90 to95 percent of high bloodpressure cases, the cause is unknown.
What can you do about high blood pressure?• Maintain a normal, healthy weight.• Decrease salt intake.• Take medications as prescribed by your physician.• Do not start smoking, and if you are a smoker, quit.
If you are experiencing symptoms of high bloodpressure, please visit your physician for diagnosisand treatment.
DepressionBrand-name drug: Prozac ($125)*Generic drug: Fluoxetine ($20)*
No one knows what triggers depression. No oneknows for sure why the brain chemistry becomesimbalanced. One factor is an imbalance in the chemicalmessengers in the brain. Age, sex, upbringing and majorlife stresses, including chronic illnesses, also can tipthe balance. Anti-depressant drugs work to restorethis balance.
WomenWomen suffer depression more frequently than men.
Typical symptoms include crying, withdrawal, inability toexperience pleasure, loss of energy and perhaps evenfeeling they would be better off dead. Women have tocope with the mood-altering hormonal effects of themenstrual cycle, pregnancy and childbirth, and meno-pause, which produce special problems.
New mothers expect to feel joy and exhilaration aftergiving birth. But because of the enormous hormonalchanges and the challenges of dealing with an infant,some women will feel short-lived sadness, often recover-ing from this on their own. Others may progress to a full-blown postpartum depression that requires medicalevaluation and intervention for recovery.
generic drugs available
* Costs represent the average cost of the prescription medication.
11Men
Some men exhibit the same symptoms oftypical depression as women, but many depressedmen exhibit atypical symptoms. Some depressedmen have what has been called hidden depression.They may manifest depression by becoming irritable,pessimistic or critical of others, having difficulty gettingalong at work, becoming aggressive or abusing alcohol.
ElderlyDepression is not a normal part of aging. It may be a
reaction to the loss of physical and mental vitality; theloss of importantothers, such asfriends, spouseand family; orhaving to giveup a career.Unexplainedcrying andpersistentsadness areoften clues, asare multiple vague physical symptoms, suchas persistent fatigue, headaches, loss of appetite, chestpain or upset stomach. If medical illness has been ruledout, depression is often the correct diagnosis.
IllnessIt’s normal to feel blue when you’ve been diagnosed
with any chronic illness. Any chronic condition cantrigger depression, but risk increases in direct proportionwith the severity of the illness and the life disruption itcauses. But it’s not normal to stay depressed. Depressionis one of the most common and potentially dangerouscomplications of every chronic illness. It is particularlycommon in those with recent heart attacks, hospitalizedcancer patients, recent stroke survivors and those whohave multiple sclerosis, Parkinson’s disease and diabetes.
Today we know the link between depression andchronic illness is a two-way street. Chronic illness isdepressing. And the depression often exacerbates theillness. Treating depression often improves the outcomesin those with other chronic illnesses.
ChildrenDepression in children often is not recognized.
Emotional and physical abuse, personal loss or having a
depressed parent increase the risk of a child developingdepression. Children often do not show the typicalsymptoms of depression. They may show their depres-sion behaviorally. They may become irritable, aggressive,have difficulty in school, withdraw from friends, or losetheir usual playfulness.
TeensAdolescence is a very difficult time in life. Major
hormonal changes are experienced at this time withhigher highs and lower lows. Family ties are beingloosened, but the teen has not yet established himself orherself as an individual. Look for problems at school,difficulty in bouncing back from life’s disappointmentsor any other sudden change in mood or behavior that isout of the ordinary. Sometimes depressed teens turn todrugs or alcohol to feel better, which ultimately makesmatters worse.
Good NewsThere is good news about depression. Once major
depression is recognized, it can be treated successfullywith medication or psychotherapy or both. Not everyoneresponds to the same therapy, but if a person doesn’trespond to the first treatment used, he or she is likely torespond to another approach.
Medication compliance is important to the successfultreatment of depression. The goal of treatment is com-plete symptom remission, not just symptom improve-ment. All patients prescribed medication should remainon the treatment through symptom resolution and thencontinued treatment for some additional months.
All patients on medication should have follow-upvisits with their physician in the initial diagnosis andtreatment phase.
GastritisBrand-name drug: Zantac ($60)*Generic drug: Ranitidine $19)*
Gastritis is not a single disease, but it means aninflammation of the stomach lining. Gastritis can becaused by drinking too much alcohol, prolonged use of
for many illnesses
(Illnesses, continued on Page 12)* Costs represent the average cost of the prescription medication.
12Sorting through massive amounts of painkillers on
the market today is enough to give you a headache.Advertising adds to the confusion. However, here’s helpfor the achy — almost all over-the-counter (OTC) painrelievers fit into one of four categories.
• Acetaminophen (Tylenol): For fever and pain, but notfor swelling. Doctors often tell people who face bleeding(from dental work or ulcers) to use this pain relieverbecause it’s the only one of the four basic types thatdoesn’t prolong bleeding.• Aspirin (Bayer, Anacin): Helps relieve fever, and minoraches and pains caused by arthritis or swollen muscles.Aspirin is known to decrease the tendency for the bloodto clot, so some people take this inexpensive drug dailyto ward off heart attacks. Before taking that step, contactyour doctor.• Ibuprofen (Advil, Motrin): Helps relieve pain, swellingand fever. Common uses for ibuprofen include relief frommenstrual cramps and arthritis.• Naproxen sodium (Aleve): Used for fever, swelling,arthritis, minor aches and menstrual cramps. Usuallylasts longer than other pain relievers on the market.
No pain with over-the-counter painkillers Did you know . . .1. Aspirin, naproxen sodium and ibuprofen work bysuppressing chemicals that send pain signals to thebrain. Acetaminophen works in the brain to dull thesensation of pain.2. All the pain relievers are available in less-expensivegeneric forms.3. Tablets, caplets, buffered or gel-coated variationsusually cost more, but are easier on the stomach.4. Read all the warning labels. For example, children andpeople with asthma shouldn’t take aspirin, peoplewith kidney problems should skip the acetaminophen,and those with high blood pressure shouldn’t takeibuprofen.
5. Signs of overdose on the pain relieving medicationinclude ringing in the ears, cramps, stomach pain andvomiting. With the exception of acetaminophen, allthese drugs can harm your digestive systems.6. OTC pain relievers and alcohol do not go together.Regular use can cause stomach bleeding orliver damage.
nonsteroidal anti-inflammatory drugs (NSAIDs), orinfection with bacteria such as Helicobacter pylori.Sometimes gastritis develops after major surgery, trau-matic injury, burns or severe infections. Certain diseases,such as pernicious anemia, autoimmune disorders, andchronic bile reflux, can cause gastritis as well.
The most common symptoms are abdominal upset orpain. Other symptoms include belching, abdominalbloating, nausea, vomiting or a feeling of fullness/burning in the upper abdomen. Blood in your vomit orblack stools may be a sign of bleeding in the stomach,
which may indicate a serious problemrequiring immediate medical
attention.Gastritis is diagnosed
through one or moremedical tests:• Upper gastrointestinal
endoscopy.• Blood test.• Stool test.
Treatment usuallyinvolves taking drugsto reduce stomachacid and thereby helprelieve symptoms andpromote healing.(Stomach acidirritates the inflamedtissue in the stomach.) Avoidance of certain foods,beverages or medicines also may be recommended.
If your gastritis is caused by an infection, thatproblem may be treated as well. For example, the doctormight prescribe antibiotics to clear up an H. pyloriinfection. Once the underlying problem disappears, thegastritis usually does, too. Talk to your doctor beforestopping any medicine or starting any gastritis treatmenton your own.
— Sources: National Digestive Diseases InformationClearinghouse, National Institute of Mental Health andthe American Heart Association
(Illnesses, continued from Page 11)
13Have you ever been
curious to know if theprescription you aretaking for your bloodpressure could have an
interaction with the medi-cation you’ve just been
prescribed for your skin rash?Well, soon you’ll wonder no more.
In addition to asking their doctor or pharmacistabout drug interactions, Arkansas Blue Cross and BlueShield members (and Health Advantage orBlueAdvantage Administrators of Arkansas members whohave their prescription benefits provided by ArkansasBlue Cross) will soon be able to go on-line to look updrug interaction information as well as find a wealth ofgeneral — and personal — information about prescrip-tion medications.
Beginning this spring, members covered by the drugbenefits provided by the Arkansas Blue Cross family ofcompanies will be able to visit their plan’s Web site andconnect to the AdvanceRx.com link for free access tovaluable information on pharmacies and pharmaceuticals.
The AdvanceRx.com link will be located within theArkansasBlueCross.com, HealthAdvantage-hmo.com andthe BlueAdvantageArkansas.com Web sites. The newfeature will allow members to:
• Look up their specific drug coverage (formularyinformation and pricing)
• Locate a pharmacy• Access a drug dictionary• Check the drug-to-drug interaction checker• Refill prescriptions and check order status (if mail
orders apply in coverage)• Check personal prescription history
New pharmacy Web site for members:
The new AdvanceRx.com link will provide memberswith current, accurate information regarding theirmedication needs and empower them to make informeddecisions about their drug benefits that should helpimprove their health and lower health care costs.
“The AdvanceRx.com link will give our members amore efficient channel for multiple transactions,” saidAlicia Berkemeyer, managerof the Managed PharmacyDivision of Arkansas BlueCross. “To date, we havebeen able to provide alimited amount of pre-scription-related informa-tion for our members onour Web sites, but thenew link will givemembers access to somuch more. And becauseAdvanceRx.com ishosted by AdvancePCS,the company thatmanages pharmacybenefits for the Arkan-sas Blue Cross compa-nies, information will be updated automatically,so members can be assured they are receiving timely andaccurate information. The new link will eliminate theneed to manually update formularies and other data.Plus, members will have access to great information24 hours a day, seven days a week.”
When the prescription history component is added,only members (those whose names are on the healthplan contract or “policyholders”) will be able to viewtheir personal prescription information. Later this year,family viewing will be implemented. Also planned forlater in 2003, members will have access to their benefitsummaries in case they have any ques-tions about what is covered undertheir plan.
To access AdvanceRx.com,members will log on to theArkansasBlueCross.com,HealthAdvantage-hmo.com orBlueAdvantageArkansas.comWeb site, and click on thelink to the Prescription Drug
(AdvanceRX.com, continued on Page 18)
C O M I N G T H I S S P R I N GC O M I N G T H I S S P R I N G
How To Use My Blueprint:14What is My Blueprint?
My Blueprint is an on-line, self-service center formembers of Arkansas Blue Cross and Blue Shield, HealthAdvantage and BlueAdvantage Administrators of Arkan-sas. The Arkansas Blue Cross family of companies strivesto meet customer expectations by providing memberswith this convenient self-help access to their health planinformation 24 hours a day, seven days a week.
What can I do by using My Blueprint?• Check member eligibility (policyholder, spouse and
dependents);• Check status of claims and claims history;• Check primary care physician (PCP) history (for those
plans that require a PCP);• Order a replacement ID card;• Update My Blueprint registration information. Where is My Blueprint?
The self-service center is available now onwww.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com and www.BlueAdvantageArkansas.com.
To access My Blueprint, click on its button on thehome page of the appropriate site. The button takes youto the log-in page. If you haven’t registered, click on theFirst-Time User link.
Why must I register to use My Blueprint?You must register on-line and receive a password by
U.S. Mail before you can enter My Blueprint. This level ofsecurity is necessary to protect your personal informationand meet federal privacy regulations.
Who can register to use My Blueprint?Only the policyholder (subscriber or contractholder)
can register, but the policyholder can see information fora covered spouse or dependent. The policyholder mustenter some basic information from his or her ID card tocomplete the registration form:• Member ID number• First and last name and middle name or initial• Date of birth
The information entered should match the ID cardinformation exactly. The only other information the formrequires is selection of two secret questions and answersto be used if you forget your password. Entering youre-mail address is optional.
How To Use My Blueprint:
Personal Benefits and Claims Tracker 15
Register for My Blueprint onArkansasBlueCross.com,HealthAdvantage-hmo.com orBlueAdvantageArkansas.com byApril 15, and you could win a $50Wal-Mart gift card. A total of 10members’ names will be drawn at
random from those who have regis-tered by that date. Look for theMy Blueprint button on the home
page of the appropriate site. Thenclick on First-Time User to register.Check your health plan ID card
if you’re not sure which companymanages your health plan. You’llneed your ID card to complete theregistration form.
What do I need to log in?A log-in ID and password are needed to log in. When
you register on-line, you receive a log-in ID. You shouldprint your registration confirmation page, which showsyour log-in ID, and save it for future reference. You willreceive your password by U.S. Mail in five to sevenbusiness days following successful registration.
After you receive your password by mail, you canreturn to the site and log in. The account must beactivated using the computer-generated ID and pass-word. After the initial log-in, you may change thepassword to something easier to remember but cannotchange the log-in ID. Please remember to keep yourlog-in ID and password private. If you log in on thewrong site, you will be directed to the site of thecompany that manages your health plan.
More than 2,700 members had registered by mid-January to use the on-line service. My Blueprint willadd additional self-help features as they are devel-oped. One recent enhancement allows HealthAdvantage members to view a copy of their expla-nation of benefits statement (EOB) for a completedclaim. The EOB shows the total charge, allowedcharge, payment to the provider and amount thepolicyholder owes.
Registerto win!
Personal Benefits and Claims Tracker
Registerto win!
16By April 14, 2003, Arkansas Blue Cross
and Blue Shield and Health Advantage willhave completed implementation ofrequirements of the Privacy Rule of theHealth Insurance Portability andAccountability Act (HIPAA) of 1996.
Compliance is mandated, but that’s notthe only reason the Privacy Rule will be inplace. Arkansas Blue Cross believes it is theright thing to do for our members, whoexpect confidentiality and privacy regardingtheir medical information and history.
“A fundamental component of theoverall service commitment we make to ourcustomers is the strict maintenance of theirpersonal information relative to both privacy andconfidentiality,” said Robert L. Shoptaw, chief executiveofficer of Arkansas Blue Cross. “This is ‘job No. 1’ foreach of us in every area of enterprise operations.”
The Privacy Rule creates national standards toprotect individuals’ protected health information and
How is my health information protected? How can I be sure?
gives individuals increased access to theirmedical records. It is the responsibility ofthose who create, maintain, or distributeprotected health information (providers,insurance companies and clearinghouses) tosafeguard this information.
As the consumer, the new law gives youcertain rights and access to yourinformation. These rights, and how toexercise them, are provided in the Notice ofPrivacy Practices (Privacy Notice)following this article. Paper copies of thePrivacy Notice and the forms associatedwith making requests will be available byApril 14 through our Web sites or by calling
your customer service representative.Members of self-funded group health plans served
by BlueAdvantage Administrators of Arkansas orUSAble Administrators, please note: the followingPrivacy Notice does not apply to you as your plan willissue its own separate privacy notice.
Human Services, if necessary to make sure yourprivacy is protected, and;
• Where required by law.Arkansas Blue Cross has the right to use and give out
your protected health information to pay for your healthcare and to perform business operations. For example:• We can use your protected health information to pay
or deny your claims, to collect your premiums or toshare your benefit payment with other insurer(s).
• We can use your protected health information forregular health care operations. Members of our staffmay use information in your health record to assessour efficiency and outcomes in your case and otherslike it. This information will then be used in an effortto continually improve the quality and effectiveness ofbenefits and services we provide.
• We may disclose protected health information to youremployer if your employer arranges for yourinsurance. If your employer meets the requirementsoutlined by the privacy law, we can disclose protectedhealth information to the appropriate areas so they canmodify benefits, work to control overall plan costs,
By law, Arkansas Blue Cross and Blue Shield and itsaffiliated company (referred to for convenience as agroup as “Arkansas Blue Cross”) is required to protectthe privacy of your protected health information. We alsomust give you this notice to tell you how we may useand give out (“disclose”) your protected healthinformation held by us.
Throughout this notice we will use the name“Arkansas Blue Cross” as a short-hand reference for notonly Arkansas Blue Cross and Blue Shield, but also for itsaffiliated company, HMO Partners, Inc., d/b/a HealthAdvantage. Please note that although we are combiningthis privacy notice in this way for convenient, short-handreference, and to make it more efficient to inform youabout your privacy rights, these companies remainseparate companies, each with their own operations,management and compliance responsibilities.
Arkansas Blue Cross must use and give out yourprotected health information to provide information:• To you or someone who has the legal right to act for
you (your personal representative);• To the Secretary of the Department of Health and
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSEDAND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
How is my health information protected? How can I be sure?
N O T I C E O F P R I V A C Y P R A C T I C E S
17and improve service levels. This information may be inthe form of routine reporting or special requests.
• We may disclose to others who are contracted toprovide services on our behalf. Some services areprovided in our organization through contracts withothers. Examples include pharmacy managementprograms, dental benefits and a copy service we usewhen making copies of your health record. Ourcontracts require these business associates toappropriately protect your information.
• Our health professionals and customer servicerepresentatives, using their best judgment, maydisclose to a family member, other relative, closepersonal friend or any other person you identify,health information relevant to that person’sinvolvement in your care or payment related to yourcare. An example would be your spouse calling toverify a claim was paid, or the amount paid ona claim.
Arkansas Blue Cross may use or give out yourprotected health information for the following purposes,under limited circumstances:• To state and other federal agencies that have the legal
right to receive Arkansas Blue Cross data (such as tomake sure we are making proper payments).
• For public health activities (such as reporting diseaseoutbreaks).
• For government health care oversight activities (suchas fraud and abuse investigations).
• For judicial and administrative proceedings (such as inresponse to a subpoena or other court order).
• For law enforcement purposes (such as providinglimited information to locate a missing person).
• For research studies that meet all privacy lawrequirements (such as research related to theprevention of disease or disability).
• To avoid a serious and imminent threat to healthor safety.
• To contact you regarding new or changed healthplan benefits.
By law, Arkansas Blue Cross must have your writtenpermission (an “authorization”) to use or give out yourprotected health information for any purpose other thanpayment or health care operations or other limitedexceptions outlined here or in the Privacy regulation. Youmay take back (“revoke”) your written permission at anytime, except if we already have acted based on yourpermission.
Your Rights Regarding Medical Information About YouBy law, you have the right to:
• See and get a copy of your protected healthinformation that is contained in a designated record
set that was used to makedecisions about you.
• Have your protected healthinformation amended if youbelieve that it is wrong, orif information is missing, andArkansas Blue Cross agrees. If Arkansas Blue Crossdisagrees, you may have a statement of yourdisagreement added to your protected healthinformation.
• Receive a listing of those getting your protected healthinformation from Arkansas Blue Cross. The listing willnot cover your protected health information that wasgiven out to you or your personal representative, thatwas given out for payment or health care operations,that was given out based on an authorization signedby you, or that was given out for law enforcementpurposes.
• Ask Arkansas Blue Cross to communicate with you ina different manner or at a different place (for example,by sending your correspondence to a P.O. Box insteadof your home address) if you are in danger of personalharm if the information is not kept confidential.
• Ask Arkansas Blue Cross to limit how your protectedhealth information is used and given out to pay yourclaims and perform health care operations. Please notethat Arkansas Blue Cross may not be able to agree toyour request.
• Get a separate paper copy of this notice.
To Exercise Your RightsIf you would like to contact Arkansas Blue Cross or
Health Advantage for further information regarding thisnotice or exercise any of the rights described in thisnotice, you may do so by contacting Customer Service atthe following telephone numbers:
Little Rock Toll FreeArkansas Blue Cross (501) 378-2010 1-800-238-8379Health Advantage (501) 221-3733 1-800-843-1329
You also may get complete instructions and requestforms from the Arkansas Blue Cross or Health AdvantageWeb sites at:
www.ArkansasBlueCross.comwww.HealthAdvantage-hmo.com
Changes to this NoticeWe are required by law to abide by the terms of this
notice. We reserve the right to change this notice andmake the revised or changed notice effective for medicalinformation we already have about you as well as anyfuture information we receive. When we make changes,we will notify you by sending a revised notice to the lastknown address we have for you. We also will post a copy
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18 of the current notice on the Arkansas Blue Cross and Health Advantage Web sites.
Complaints If you believe your privacy
rights have been violated, you may file a complaint withArkansas Blue Cross or one of its affiliated companies, orwith the Secretary of the U.S. Department of Health andHuman Services. You may file a complaint with ArkansasBlue Cross or one of its affiliated companies by writing tothe following address:
Privacy OfficeATTN: Privacy OfficerP.O. Box 3216Little Rock, AR 72201
We will not penalize or in any other way retaliateagainst you for filing a complaint with the Secretary orwith us.
You also may file a complaint with the Secretary ofthe U.S. Department of Health and Human Services.Complaints filed directly with the Secretary must: (1) bein writing; (2) contain the name of the entity againstwhich the complaint is lodged; (3) describe the relevantproblems; and (4) be filed within 180 days of thetime you became or should have become aware ofthe problem.
Effective DateThe provisions of this Notice become effective
April 14, 2003.
Information section. Members will be required to registerto gain access to their personal information. Personalhealth information will be strictly confidential andaccessed by members through a log-in ID and password.
Just some of the information members will haveaccess to through the AdvanceRx.com link includes:
Drug Coverage — Throughout a member’s on-linesearch in AdvanceRx.com, information is available forgeneric/preferred/formulary indicators and a link tocoverage and pricing. Members may search for informa-tion about drugs either by drug name or therapeuticclass. They also may look up therapeutic alternatives andget real-time pricing for those medications. Since the datarequests are driven by the member’s benefitscomposition, all information will beaccurate according to the member’shealth plan. The member will knowcoverage and savings information,and remaining deductible andbenefit cost information, as well asper-day cost, annual cost if amaintenance medication, and homedelivery vs. retail cost.
Personal Prescription History —Soon, members will be able to access theirprescription claims information, which will give them afull picture of all of the prescription medications they aretaking or have taken.
Pharmacy Locator — The Pharmacy Locator helpsmembers find a convenient retail pharmacy.
Drug Dictionary — A comprehensive drug dictionaryallows members to look up the name of their medicationand find out what all of the “-tens,” “-cins,” “-prils” and“-zenes” mean.
Drug-to-Drug Interaction Checker — By typing in thenames of their prescription medications, members canfind out if they are likely to experience any side effects orinteractions with the drug-to-drug interaction checker.
Refill Prescriptions & Check Order Status — If theirbenefits allow members to receive prescriptions by mailorder, information is just a click away on how to refill
“scripts” and check on orders placed.
“We believe the AdvanceRx.com link willprovide better knowledge of health issues andbenefit details and can encourage appropriatedrug use,” said Berkemeyer. “This is anotherexample of how Arkansas Blue Cross isconnecting our members to leading edge
health care services.”
(AdvanceRX.com, continued from Page 13)
(Privacy, continued from Page 17)
The Pharmacist is inDo you have any questions?
The Pharmacist is inDo you have any questions? 19
Arkansas Blue Cross and Blue Shield’s Web site,www.ArkansasBlueCross.com, recently receivedrecognition on two fronts.
The site ranked in the “top 16” for on-line servicesamong 97 Blue Cross and Blue Shield Plans and othercommercial payors in a recent study conducted by CapGemini Ernst & Young Group, one of the largestmanagement and information technology consultingorganizations in the world. The site also was ranked asthe state’s “Best Insurance Site” in the 2002 ArkansasBusiness Best of Arkansas Web Awards.
Cap Gemini Survey of “Payor” Web SitesThe Cap Gemini study evaluated Web site
Arkansas Blue Cross recognized as leader in Web site performanceperformance based on the followingattributes of Web sites typicallyexpected by customers:• Secure — Leading Web sites use passwords and/or
encryption to restrict access to sensitive information.• Extensive — Leading Web sites offer a variety of on-
line services that are valuable to their customers.• Accessible — Leading Web sites offer customer
services, provider directories and log-ins for securemember/provider information directly to users on thehome page.
• Connected — Leading Web sites have links to othersites that offer health information.
Pharmacists frequently get questions about theeffectiveness of a generic medication when compared toits brand-name counterpart. Here are some facts thathelp provide the answers to these questions.• The term “generic” has been misused and abused over
the years due to association with alternate foods,clothes or devices that may have exhibited inferiorqualities when compared to the “original.” Genericmedications are alternate choices to a formerlypatented drug and are less expensive because multiplemanufacturers are competing in the same marketplace.
• The U.S. Food and Drug Administration (FDA) ischarged with evaluating all medications in regard totheir safety for human use and their effectiveness forthe treatment of designated medical conditions. After adrug patent expires, other manufacturers must submitdata to the FDA that ensures their drug is both phar-maceutically equivalent and bioequivalent to thepioneer or innovator drug before they are allowed tomarket these drugs.
The following criteria are applied by the FDA toverify drug equivalence before issuing approval forhuman use:1. Pharmaceutical Equivalence
The FDA must assure that equivalent drugs, whethergeneric or brand name, contain the same active ingredi-
ents, same dosage form, are identical in strength, havethe same route of administration, and meet the samestandards of quality and purity. Equivalent medicationsmay differ in physical characteristics such as color,shape, scoring, flavor and preservative if used.2. Pharmaceutical Bioequivalence
This is a measurement of the rate and extent towhich the active ingredient of a drug becomes availableat its site of action. Bioequivalence of different formula-tions of the same drug from multiple manufacturers isdetermined by the rate of absorption and the comparisonof blood level concentrations of those drugs in healthyadults. These comparisons must meet the standardsestablished by the FDA.
Fair and reasonable prices of any product in a freemarketplace are heavily dependent upon competition.The discovery of any new invention is accorded somemarketplace protection through patent security to allowthe inventor some prosperity. This protection encouragesthe invention process to continue and grow by rewardingfuture inventors and providing new and better productsfor purchasers.
The competitive marketplace, after patents expire,must thrive so that affordable prices will remainavailable.
(Web, continued on Page 20)
• Customized — Leading Web sites have tailoredtheir design and offerings to address members’individual needs.
Sixteen Web sites were able to meet two or more ofthe above criteria. In addition to Arkansas Blue Cross,Montana Blue Cross and Blue Shield, New Jersey BlueCross and Blue Shield (Horizon), South Carolina BlueCross and Blue Shield, and North Carolina Blue Crossand Blue Shield also were included in the top 16. Theinformation for the evaluation was gathered betweenSeptember and October 2002.
Best of Arkansas Web Awards“Dynamic … easy to use … functional” is what
Arkansas Business, the state’s weekly business journal,looked for when it set out to find the state’s best Internetsites. “The Web site for the state’s largest healthinsurance company does a great job of conveying itsmyriad of information in an organized manner,” thejudges said. “A personal benefits and claims tracker,along with sections providing rate quotes and legislativeupdates, keeps the site user-focused. And BlueAnn’s
Wild and Woolly Web Site offers games, music videos,a weekly poll and other interactive tools for youngerviewers.”
Farm Bureau of Arkansas was first runner-up with itswww.arfb.com site.
Judges included Steve Asmussen, informationtechnology director, BAPTIST HEALTH; J. EdwardHorton, marketing and alliances leader, Acxiom Corp.;Tom Allen, president, Avow Technology Solutions;Russell Shain, dean of the College of Communications,Arkansas State University; Wayne Chapman, associateprofessor of theater arts and member of CyberCollege ITfaculty, University of Arkansas at Little Rock; PamelaSchmidt, associate director, Information TechnologyResearch Center, University of Arkansas; Dan Delaughter,director of management of information systems,Arkansas Department of Arkansas Parks and Tourism;Michael Preble, associate director-education, ArkansasArts Center; David Snyder, general manager-interactivedivision, Crain’s Chicago Business; and Jeff Ireland,president, virtuallythere.net, Fort Worth, Texas.
(Web, continued from Page 19)
20As part of a continuing customer education cam-
paign on escalating health care costs, Ray Bredfeldt,M.D., regional medical director, of Arkansas Blue Crossand Blue Shield’s Northwest Regional Office inFayetteville, recently presented “Facing the Challenge ofHigher Health Care Costs” during a series of localBusiness Leadership Forums.
Claudia Gardner, the region’s medical affairs man-ager, said the message was timelybecause many companies areweighing the heavy decision ofwhether to offer future health carebenefits. “Our primary goal was todevelop a presentation for thechief executive officer/decisionmaker audience that would armthem with the latest trends inhealth care and give them aglimpse into the future of employee health care costs,”she said.
“Additionally, we wanted to provide the participantswith information regarding our new benefit options —MyChoice Blue, BlueFlex® PPO, Group BasicBlue®,
Fayetteville office sponsors educational seminars
MSA Blue®, Open Access Point ofService and our Consumer-DrivenHealth Plan,” said Gardner.
Regional Executive MelBlackwood, who facilitated aportion of the forum, said much ofthe audience lacked key information on the reality offuture health care costs. “From their questions and
feedback, we identified commonalties, aswell as specific concerns,” he said. “Weare working to tailor our proposals tomeet their needs with consumer-drivenhealth care products.”
More than 120 business leadersattended the forums, which were held inSiloam Springs, Harrison, MountainHome, Bentonville and Fayetteville fromOct. 28 through Nov. 15, 2002. Several
network hospitals, including Siloam Springs MemorialHospital, North Arkansas Regional Medical Center,Baxter County Regional Medical Center, St. Mary’sHospital and Washington Regional Medical Centerco-sponsored the events.
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
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Ray Bredfeldt, M.D.
Bredfeldtspeaks atBusiness
LeadershipForum.
21Cardiovascular disease (CVD) is
the No. 1 cause of death in Arkansas.High blood pressure affects almostone-third of adult Arkansans. Thestroke rate in Arkansas is the secondhighest in the United States.
The Arkansas Department ofHealth is in its second year of funding from the Centersfor Disease Control and Prevention to develop a stateplan to reduce CVD in Arkansas. Arkansas Blue Crossand Blue Shield is one of the more than 60 partners fromthe private sector, government and non-governmentorganizations throughout the state who have joined theArkansas Cardiovascular Task Force to assist in develop-ing the state plan.
The overall goals of the plan include: taking action todelay the onset of CVD and postpone death due to CVD;making Arkansans aware of the risk factors and whateach person can do to affect their risk; promotingenvironmental changes to improve access; and establish-ing policies that support and encourage healthy lifestyles.The Task Force has been organized into five workgroupsto develop goals, objectives and action steps for the stateplan. The groups are Health Care, Physical Activity,Nutrition, Tobacco Use and Advocacy.
The Task Force has compiled a Cardiovascular HealthResource Directory. It includes descriptions of members’
Arkansas Blue Cross and Blue Shield joinsArkansas Cardiovascular Task Force
on-going programs related to CVD and an inventory ofstate and federal laws and regulations. According toLinda Faulkner, Cardiovascular Health Program leader,among the Directory’s programs listed are those thataddress increasing physical activity, eating a healthy diet,smoking cessation, diabetes, hypertension and highcholesterol. “Commitment of partner resources, hardwork and creative thinking are required to develop astate cardiovascular health plan that will make a differ-ence in the health of Arkansans.”
Some of Arkansas Blue Cross programs which metthe criteria and are profiled in the directory include: Blue& Youth health programs, which is aimed at improvingthe health of young Arkansans, Don’t Start, whichfocuses on teaching elementary students the dangers ofsmoking, and the Enterprise Health Education Programs,which provide health information and resources tomembers regarding cardiovascular disease, diabetes andhealthy lifestyles.
The Cardiovascular Health Program also partneredwith the Arkansas Wellness Coalition to provide cardio-vascular disease principles, chart tools and patienttracking tools to more than 3,600 physicians last year.Arkansas Blue Cross is a member of this organizationand assisted in the development of these tools, whichwere based on the American Heart Association guidelinesfor CVD.
In September 2002, a survey was conducted tomeasure how satisfied the statewide network of primarycare physicians (PCPs) are with Health Advantageservices as they relate to state and public school employ-ees in Arkansas.
According to the survey, the majority of physicianssurveyed were satisfied with the services received fromHealth Advantage. Each question scored a mean of atleast “4” on a 5-point scale with “1” being not satisfiedand “5” being very satisfied.
Results:• Overall experience with Health Advantage — 96
percent of respondents gave Health Advantage a ratingof 3 or higher.
• Claims were handled accurately by Health Advan-
tage — 94 percent of respon-dents gave Health Advantage a rating of 3 or higher.
• Claims were handled timely by Health Advantage —94 percent of respondents gave Health Advantage arating of 3 or higher.
• Answers provided by Health Advantage CustomerService were accurate — 95 percent of respondentsgave Health Advantage a rating of 3 or higher.
• Inquiries provided by Health Advantage CustomerService were handled promptly — 94 percent ofrespondents gave Health Advantage a rating of 3or higher.
Every PCP in the Health Advantage network receivedthe survey, including 787 individuals and PCP clinics. Ofthe 787 surveyed, 365 responded (46.4 percent).
Physicians express satisfactionwith Health Advantage
Blue & You readers pleased withmagazine, Internet services22
Readership surveyThanks to plenty of health-
and-wellness and health insuranceinformation, Blue & You readerstold Arkansas Blue Cross and BlueShield loud and clear that it issomething they appreciate andfind helpful. The Autumn 2002issue had a readership survey (anannual process) enclosed for members to return withcomments, and customers gave Blue & You an average of4.54 on a five-point scale (with 5 being the highestrating). The survey respondents gave Blue & You a meansatisfaction rate of 4.63 in the category of Design; a 4.74in the category of Easy to Read; and a 4.61 in the cat-egory of Content. Compared to results from the 2001readership survey, respondents gave Blue & You highermarks in every category.
More members visit Web sites, find information usefulThe results of the 2002 Internet Survey showed that
Arkansas Blue Cross, Health Advantage andBlueAdvantage Administrators of Arkansas membershave increasing access to the Internet and an increasingawareness of the companies’ Web sites.
A survey card was enclosed in the Autumn 2002issue of Blue & You. The 2002 survey had fewer returnsthan the 2001 survey — 520 compared to 2,363.
Those who responded found the most useful sectionsof the sites to be “Health Plans and Services,” “Prescrip-tion Drug Information” and “Provider Directory.”
When asked to rate self-service features they wouldmost like to see on the site, the top three were:
Blue & You readers pleased withmagazine, Internet services
1. Review benefits.2. View physicians’ backgrounds.3. View health and wellness information.
This question addressed features not currently on thesites but under consideration for development in the nearfuture. Several of the features listed in the 2001 surveyalready have been added tothe sites, so those wereremoved from the 2002survey. One example is“check claims status,”which is now available onthe Arkansas Blue Cross,Health Advantage and BlueAdvantage sites.
The number of respondents who have Internetaccess increased from 70 percent in 2001 to 79 percent in2002. The number who have visited the Web sitesjumped from 28 percent in 2001 to 44 percent in 2002.Sixty-three percent of those responding rated the valueof the site at 4 or 5 on a five-point scale, with 5 beingthe highest.
Gift certificate winners!From the Blue & You satisfaction survey, we ran-
domly selected three winners who each received a $50gift certificate to Wal-Mart. The winners were PatHarrison of Mena, Charlotte Wigley of Hamburg andErwin Hall of Little Rock.
From the Web site satisfaction survey respondents,we also randomly selected three winners who eachreceived a $50 gift certificate from Best Buy. The winnerswere Lois Evans of Russellville, Helen Holt ofMurfreesboro and Steve Martin of Yellville.
“WELLNESS” CONTEST WINNERS ANNOUNCEDIn the Autumn 2002 issue of Blue & You,
Arkansas Blue Cross and Blue Shield sponsored a“Discount Wellness Program” contest for mem-bers. Members had a chance to win one of four
$50 gift certificates. To win, members simply had to takea look at the discount listings onany of our four Web sites andcorrectly answer a few simplequestions. The four winners have all
received their gift certificates. They could selectfrom Wal-Mart, Target, Sharper Image and SimonProperties (mall certificate). The winners were
Jerry Reinhart of Paragould,Charlotte Wicks of West Memphis,
Vinie Holt of Hope, and ChristyRothgery of Jonesboro.
The results are in!The results are in!
“WELLNESS” CONTEST WINNERS ANNOUNCED
ambassador, is on hand to perform with the Heroes asoften as possible. The “BlueAnn Stomp” ties in the HighSchool Heroes anti-smoking message and BlueAnn’swellness message, which is taken statewide as well.
And the message needs to be shared.Every day, an average of 3,000 kids start smoking in
America. The average age for kids to first start experi-menting with smoking and tobacco use is 11 — and thetrends show that age is getting younger. Most smokersstart smoking before the age of 20 — few start after age18. In Arkansas, more students in grades 9-12 smokethan in 39 other states, and more than 250,000 peoplesuffer with incurable lung diseases caused by smoking.Almost 27 percent of Arkansans smoke, putting our stateamong the top tobacco-using states (only seven otherstates have more smokers).
Since its introduction in April 1996, the High SchoolHeroes program has grown from being offered in threecounties to now being offered in 41 counties. In almostseven years, more than 7,281 Heroes have been trainedto teach the program and more than 104,810 elementaryschool students have been reached with the message.Supporting the Heroes on campus are the more than 80counselors and advisers who annually help schedulepresentations and get the Heroes ready to roll — they areheroes as well.
The High School Heroes program definitely has theingredients to spell success with students, and ArkansasBlue Cross is committed to helping the future generationof health care users to be their healthy best.
Watch for more information about the High SchoolHeroes program in future issues of Blue & You. And ifyou are interested in more information about the pro-gram or how it can come to your school district, call theAmerican Lung Association of Arkansas at 501-224-5864,or toll-free at 1-800-586-4872.
23Good news, Spider-Man and Powerpuff Girls, there’s
a group of Arkansas heroes that is prepared to kick “butts”and put out fires with you. In fact, these heroes have beendoing a lot of “stomping,” all in an effort to stem the tideof tobacco use in “the natural state.”
Who are these champions of clear lungs, thesedefenders of adolescents?
They are the High School Heroes — a group of highschool pupils currently 2,073-strong who are on amission to share with younger students that smoking isnot cool and tobacco is one ugly substance.
Capeless and clad in blue jeans, white T-shirts andsneakers, the High School Heroes are an inconspicuous,although elite, group of students who may not haveachieved super hero status yet, but certainly are elevatedin the eyes of elementary school students who look up tothem as role models.
Arkansas Blue Cross and Blue Shield has sponsoredthe High School Heroes program since its inception.Developed by the American Lung Association of Arkan-sas, High School Heroes is a unique, student-to-studentteaching program with a strong anti-smoking message.
Through High School Heroes, specially-trained highschool students present an anti-smoking program tar-geted to fourth-, fifth- and sixth-graders in their schooldistrict. High School Heroes serve as role models for thekids, pledging to remain smoke-free and delivering astrong testimony about the dangers of smoking and theappeals of tobacco advertising.
Using brainstorming, role-play, discussion andquestion-and-answer, Heroes present their message withthe goal of reaching kids at an age when peer pressureand advertising might entice them to start smoking. Thediscussion includes information about the effects ofsmoking on the body as well as the deceptive appeals oftobacco advertising.
As part of their presentation to students, the HighSchool Heroes teach the “BlueAnn Stomp,” a rap-
dance created by the NorthLittle Rock High School“Stars” with musiccomposed by Hans
Stiritz of Russellville.BlueAnn Ewe,
Arkansas BlueCross’health
Super Heroes Hang Outin High Schools
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Oak Grove High School Heroes “stomp” with BlueAnn.
Arkansas Blue Cross and Blue ShieldP.O. Box 2181Little Rock, AR 72203-2181
PRSRT STDU.S. POSTAGE
PAIDArkansas Blue Cross
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through the Department of Education and are beingmailed to home-school programs. In addition, StoryboardContest sheets can be picked up at any Arkansas BlueCross location, at the American Lung Association ofArkansas, and at Clear Channel Communications in LittleRock, or by calling toll-free, 1-800-586-4872, ext. 118. Formore information, visit BlueAnn’s Web site atwww.BlueAnnEwe-ark.com. The “Don’t Start” SmokingStoryboard Contest will help your kids draw a healthymessage today, as well as a good breath, for life.
Arkansas Blue Cross and Blue Shield strives to be agood corporate citizen. Our employees raise money andspend many hours helping those causes near and dear tothe hearts of Arkansans.
Making Memories and FriendsStaff members of the Northwest Regional office laced
up their sneakers to join the Alzheimer’s Association forits Memory Walk inFayetteville. More than300 people participatedin the first annual eventheld at the NorthwestArkansas Mall to raiseawareness of thedisease and money tosupport Alzheimer’spatients and theirfamilies. BlueAnn wasthere to greet walkersand have fun with the participants. The walk raisedabout $16,000 for the cause.
“Don’t Start” 2003 Gets StartedArkansas Blue Cross is once again joining the
American Lung Association and the Arkansas Depart-ment of Education to encourage kids to not start smok-ing. Media partners KASN-TV/UPN Channel 38 andKLRT-TV/FOX Channel 16 are joining the effort as well.The “Don’t Start” Smoking Storyboard Contest 2003 runsthrough March 28, and is an effort to give kids in kinder-garten through fifth grade an opportunity to write a storyabout why it’s important to never begin this dangeroushabit. Kids can “draw their way” to some great prizesand an opportunity to have their story transformed into atelevision Public Service Announcement (PSA) to bebroadcast in Arkansas in the summer and fall of 2003.This is the second year for Arkansas Blue Cross tosponsor the program. In 2002, almost 10,000 studentsparticipated in the contest! David Clarke, a then fifth-grader at Pulaski Heights Elementary School in LittleRock, was the grand-prize winner of the contest. Theother 17 finalists came from all four corners of the state.
Storyboard Contest sheets and educational videoshave been distributed to all public and private schools
BlueAnn makes friends at theMemory Walk 2002.
Students from Martin Luther King Elementary in LittleRock promote “Don’t Start” on KATV-TV, Channel 7.
GREAT NEWS!
Coming Soon — Arkansas Blue Cross and Blue Shield will beintroducing a dental product just for individuals (under age65) and families. If you’d like to learn more, please give us acall at 1-800-392-2583.
