A generic drug is identical to a brand name drug in safety, strength, quality and performance. The generic drug substitution program requires that generic drugs be dispensed. Therefore, if a beneficiary chooses a brand name drug when a generic drug is available, they will need to pay the difference between the costs of the brand name drug and the generic drug.
If a beneficiary has already tried and cannot take the generic drug due to a specific medical reason(s), their doctor should fax a letter of medical necessity to 1-888-487-9257 to provide medical information as to why the generic medication should not be dispensed. If approved, the beneficiary will not pay the difference between the brand name drug and the generic drug.
Review Generic Specialty Preferred Product Drug List here.
Review Medical Necessity Form here.