Members pay the difference between brand-name and generic drugs

On July 1, 2009, we began consistently administering our policy of members paying the difference in cost between brand-name and generic drugs. If required by your plan, here’s what this means for your employees:

• If members or their physicians request a brand-name drug when a generic is available, members pay the difference in cost between the brand name and the generic.
• In the past, physicians could request coverage for brand names based on “medical necessity” when the generic was deemed ineffective. We’re now considering these requests only under certain circumstances (see below).

Some important points to note:

• Members who had prior authorization for brand-name drugs prior to July 1, 2009, have been grandfathered and pay only their brand-name copay.
• Exceptions are available for rare cases such as color blindness, allergies, etc.
• Physicians of members who are currently stabilized on medication for epilepsy can request a Dispense As Written (DAW) exception.

Please contact your account representative if you have questions.