How do you increase the dispensing rate of generic prescription drugs in a state that's in the backyard of some of the largest name-brand pharmaceutical companies? That was the dilemma facing Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare Services Inc., New Jersey's largest health insurer.

In July 2002, New Jersey was lagging behind the national curve with a 32.5% generic dispensing rate. Horizon, with 2.9 million members, was feeling the pressure to cut costs. The way Jay Patel, Pharm.D., manager of business development for Horizon, explained it, the goal was to create cost savings by promoting generic medications. Not an easy task in a state where doctors see more name-brand drug reps than in any other region of the country. Horizon, however, launched two novel programs that have to date resulted in a steady increase in the generic dispensing rate.

In the first initiative, Horizon joined forces with MedVantx, which is based in San Diego. Through MedVantx's AdvantagePoint Network, ATM-type machines were placed in physicians' offices throughout the state. Thirty-day supplies of generic medications are prescribed to patients who can then access the drugs free of charge via the ATM in their doctor's office. "It puts the doctor in the position to start the patient on a generic drug without a co-pay," said Patel.

But for some pharmacists, including Denise Hayes, R.Ph., M.S., owner of Haworth Apothecary in Haworth, N.J., the MedVantx program is troubling because the prescription is not coming to the pharmacy. Hayes is concerned that because the patient is getting a sample at the doctor's office, the physician might not be fully aware of what other medications the patient is taking. "It's all about the insurance company trying to save money, not about what's in the best interests of the patient," she complained.

In addition to the MedVantx program, Horizon has stepped up its generic campaign through more conventional promotional tools, including newsletters and generic co-pay waiver coupons. Horizon is also using speech-recognition technology to contact plan members by telephone. The goal is to identify those individuals who are using multisource brand drugs and inform them about generics.

Five to seven days prior to their next refill, phone calls are made to Horizon members who have their Rxs filled at a retail pharmacy. They are reminded that it is time for a refill and are prompted to answer, via speech-recognition software, questions about their current medications. They are offered an opportunity to switch from the brand name to a generic version of the drug that they're currently taking.

"It informs the members about generics and makes them aware of the cost savings," said Patel. It also gives Horizon an opportunity to identify some of the reasons members are averse to using generics.

Since the program was launched in October 2004, Horizon has increased its generic drug utilization rate from 30% two years ago to 40% today.