For years we have been able to hold some of the increase in overall medication costs by the 1%-3% annual increase in generic utilization. As overall generic utilization is somewhere in the mid-high 70%… there has got to be a ceiling of generic utilization.. unless all R&D just stops and no new products start coming on line, may be there now. Where do we go? We have seen step therapy being instituted on patients put on new medications… some are now seeing step therapy being imposed on patient on stable medication therapy. How much extra cost are these going to borne by the patients in having to pay repeated co-pays when step therapy does not get the patient back to where they were on the original medication. I know where I work, we are advised – by the computer – when a doctor or medical director has signed a general letter authorizing therapeutic interchange (TI) on all Rxs…where applicable. If we don’t do the TI when prompted to do so… clinical intervention dept WANTS ANSWERS as to why the prompt was ignored. I would say that <1% of the prescribers come back and over rides the TI. Here is a article in THE WASHINGTON TIMES where a prescriber’s opinion seems to believe that all of this TI is driven by profit to be gained by pharmacies. We are all being deluged with the benefits of MTM…but… everything about MTM seems to be focused on reducing costs.. and hoping that you maintain the patient existing disease state and quality of life… Improving the patient’s quality of life… seems to be only a after thought. Are the PBM’s & insurance companies going to place prescribers and Pharmacists at odds over the next cost savings fad?