Generic drug substitution

Priority Health has a generic substitution policy that mandates coverage of generics when an A-rated or equivalent generic is available. Currently, if a member or physician requests the brandname product, the member may have to pay the difference in cost between the brand and generic drug cost, plus their copay. This is known as member pay difference (MPD).

DAW prescriptions can be prescribed and filled. Authorizations for the MPD override may be given for the following exceptions:

• Members on Coumadin® (no authorization required, automatic brand copay)
• Patients who are color-blind and require a specific brand for identification purposes
• Patients with a documented allergy to an inactive component to the generic product
• Patients currently stabilized on brand medications for epilepsy may have their physicians request continuation on the brand with no MPD (brand copay still applies). Members starting on epilepsy therapy, or those taking anti-epileptic medications for indications other than epilepsy, will be required to pay the MPD if a brand is chosen.

Topics: Generics