Generics policy

Priority Health requires that, when available, AB-rated generic equivalents must be used instead of non-preferred brand-name drugs.

Brand name drugs which have a generic available are non-formulary or non-preferred. If a member chooses to fill a non-preferred brand name medication or the prescriber writes DAW on the prescription, the member must pay the difference in cost between the brand and generic, known as Member Pay Difference (MPD), plus their corresponding member cost-share for the drug. Non-formulary brand drugs with a covered generic equivalent on the Approved Drug List are not covered.

What is an AB-rated generic drug?

To earn an AB rating from the Food and Drug Administration (FDA), a generic drug must be identical to the non-preferred brand name version in:

• Active ingredients
• Dosage (the amount you take each time)
• The amount of active ingredients delivered to the bloodstream within the same time period

AB-rated generics usually have different shapes and/or colors than their corresponding non-preferred brand-name drugs, and of course they're usually much lower in cost.

How do I know if a generic drug is AB-rated?

Pharmacies carry primarily AB-rated generic equivalents. Your pharmacist will be able to tell you if a generic drug is AB-rated.

Definitions

Dispense as written (DAW): refers to requests for drugs to be provided exactly as written by the prescriber. For example, if a prescription is written for a branded drug that has a generic product available, and applicable pharmacy law allows generic substitution, a provider may write for the brand name drug and include “DAW” if the provider intends for the prescription to be dispensed for the brand name drug only.

Member Pay Difference (MPD): the difference in cost between a covered brand name drug and the FDA Orange Book A-equivalent generic version; and this difference in cost is what a member pays (in addition to applicable copay, deductible, etc.) if choosing the branded product when a generic is available.