<p>We saw our copays double for drugs this year, so I finally decided to try the generic for one drug. The insurance refused to pay for the generic. I have not heard of this before - has anyone any insight into this refusal? Is this a new trend, or a special case? The pharmacist said it was ‘weird’ but it sometimes happens.</p>
<p>I’ve only ever seen that on a few rx’s… do you know what the name of the generic is?</p>
<p>It seems unusual. Our insurance is the polar opposite. If there is a generic available and we don’t use it then we have to pay the full difference between the cost of the generic and the non generic.</p>
<p>* insurance is the polar opposite. If there is a generic available and we don’t use it then we have to pay the full difference between the cost of the generic and the non generic.*</p>
<p>Ours too, however several of my meds are brand new so no generic.</p>
<p>this can happen if there are multiple drugs in the same class…ie even though there are generics of, lets say, anticonvulsants… they may want you to use the least expensive generic first… or get a prior authorization to over ride.</p>
<p>Perhaps the contracted, discount price for the generic is less than the cost of your Rx deductible? For example, you have an Rx deductible of $25/yr and the generic was $5.00?</p>
<p>btw: for some/many generics, Target & Walmart offer great deals and don’t even file with your insurance.</p>
<p>Yes, many drugs at Walmart are generic for $5 a month and $12 for 3 mos. In those cases you just pay as the entire cost if the drug is at or under the copay. Even at your every day pharmacy it may NOT be that they REFUSED, but that your portion due COVERED the entire amount.</p>
<p>The pharmacy can tell if that were the case. If not, call the 1-800 number and they can tell you what the preferred drug/generic is.</p>
<p>With your new year you also may have a new drug deductible.</p>
<p>^that’s happened to me. The copay is 20, and sometimes something is less than that. The clerk always says “they refused it” but what s/he really means is that it costs less than the copay, so there’s nothing for them to pay.</p>
<p>There is an 800 number on the back of your prescription insurance card. The customer service people should be able to explain your coverage to you.</p>
<p>Thanks - that makes sense. Stay tuned.</p>
<p>There’s a deeper problem in some cases. The pharmacy benefit managers, like Medco, cut deals with some of the suppliers and get rebates based on purchasing volume of certain brand name drugs, which they’re not required to pass along to the consumer. It is disclosed in the details of the benefits plan, but you find it only if you read several dozen pages of tiny print. </p>
<p>We have that issue with one drug for which the name brand is about $215 a month, and the generic about $165. It is not a drug where there are known differences between the brand name and the generic, as was found to be a problem with some of the psych drugs. </p>
<p>The formulary treats the name brand as being on the approved list, but not the generic. They make it very hard to get the generic dispensed, but since we pay the full cost of drugs until we meet our family’s high deductible, I’m not willing to pay an extra $600 a year so that they can collect a rebate. I made a bunch of phone calls, and have a good pharmacist who made repeated phone calls to get the appropriate override code. </p>
<p>Personally, I think that Medco and similar companies being able to take rebates while at the same time being allowed to dictate which brands are approved ought to be illegal, but apparently it is not.</p>