Common use of Generic Drugs and Generic Substitution Clause in Contracts

Generic Drugs and Generic Substitution. Our Pharmacy Benefits Manager has classified generic drugs. Generic drugs have the same active ingredients, must meet the same FDA rules for safety, purity and potency, and must be given in the same form (tablet, capsule, cream) as the Brand Name Drug. When you are prescribed a brand name drug and a generic option is available, your pharmacy will automatically fill the prescription using the generic drug. If, for medical reasons, you require the brand-name drug, you can request your Provider obtain Prior Approval from our Pharmacy Benefits Manager of the brand-name drug. Your Provider will need to submit clinical information to support why you need the brand-name drug instead of the generic. If Prior Approval is granted, you will pay the applicable cost associated with the brand-name drug as described on the formulary. Your Provider can also request (or submit on your behalf) a prescription for a brand-name drug by writing “dispense as written” on the prescription. This requires the pharmacy to fill the prescription for the brand-name drug. If “dispense as written” is on the prescription, you will pay the non-preferred brand drug cost-sharing plus a ‘dispense as written” penalty of the difference in price between the brand-name and generic drug. The penalty does not apply to your Out-of-Pocket costs.

Generic Drugs and Generic Substitution. Our Pharmacy Benefits Manager has classified generic drugs. Generic drugs have the same active ingredients, must meet the same FDA rules for safety, purity and potency, and must be given in the same form (tablet, capsule, cream) as the Brand Name brand-name Drug. When you are prescribed a brand brand-name drug and a generic option is available, your pharmacy will automatically fill the prescription using the generic drug. If, for medical reasons, you require the brand-name drugdrug not listed on the formulary, you can request your Provider obtain Prior Approval from our Pharmacy Benefits Manager of the brand-name drug. Your Provider will need to submit clinical information to support why you need the brand-name drug instead of the generic. If Prior Approval is granted, you will pay the applicable cost associated with the brand-name drug as described on the formulary. Your Provider can also request (or submit on your behalf) a prescription for a brand-name drug listed on the formulary where there is a generic equivalent available, by writing “dispense as written” on the prescription. This requires the pharmacy to fill the prescription for the brand-name drug. If “dispense as written” is on the prescription, you will pay the non-preferred brand drug cost-sharing. If your Provider does not deem the brand-name drug medically necessary and you choose to have the pharmacy fill the prescription with the brand-name drug, you will pay the non-preferred brand drug cost-sharing plus a ‘dispense as written” penalty of the difference in the price between the brand-name drug and generic drug. The penalty does not apply to your Out-of-Pocket costs.