Most doctors want to help keep their patient's health care affordable. However, some doctors may not know when generic drugs become available for certain prescription drugs. Further, doctors may not know that generic drugs cost about 30 to 80 percent less than brand-name drugs. You, as the patient, may know more about your prescription drug costs than your physician. With rising drug costs, it may be time to talk about your prescription drug costs with your physician.
We know talking to your doctor about generic drugs and how you can reduce your prescription drug costs may be uncomfortable or confusing. To help you, we have three questions you can ask whenever your doctor prescribes a brand-name drug.
- Is there a generic drug that I can take instead of the brand-name drug you have prescribed?
Doctors often have several medication options they can prescribe for your condition. Generic drugs account for more than half of all prescriptions. If your brand-name drug does not have an equivalent generic drug, there may be another generic drug available to treat your condition. - Will a generic drug provide effective treatment for me?
The US Food and Drug Administration (FDA) has indicated that generic drugs can be expected to work as well as the original brand-name drugs, because generic drugs have the same active ingredients. FDA-approved generic drugs also have the same quality and strength as brand-name drugs. You and your doctor can determine if generics are right for you. - Would a 90-day supply of medication be appropriate for me?
If you use a medication on a long-term basis and you have Standard Option, you could save the most money by ordering a 90-day supply of a generic drug through our Mail Service Pharmacy Program. Basic Option benefits do not include a Mail Service Pharmacy Program.
How much can you save using generic drugs?
The amount you save using generic drugs instead of brand-name drugs depends on the number of prescriptions you take. In addition, your savings may also depend on whether the prescription is for a chronic or long-term condition, or if the prescription is required for a short time, perhaps to treat an infection.
If you purchase your drugs at a Preferred retail pharmacy, the pharmacy has agreed to accept the Plan Allowance as payment in full. If you use a Preferred Pharmacy, your savings are at least 10 percent of the Plan Allowance under Standard Option.
| Your Generic Cost | Your Brand-Name Cost | Savings |
|---|---|---|
| 20% of the Plan Allowance | 30% of the Plan Allowance | Generic drugs cost less than brand name drugs, so you are paying 20% of a lesser amount. Your savings is at least 10% of the Plan Allowance. |
| The coinsurance amount is waived for the first four prescription fills or refills when you switch from a brand name drug to a generic drug. See the 2010 brochure for eligible drugs | 30% of the Plan Allowance | These eligible generic drugs will save you the 20% coinsurance amount you would pay when you use other generic drugs. |
If you have Basic Option and use a Preferred retail pharmacy, you can save at least $25 on each prescription.
| Your Generic Cost | Your Brand-Name Cost | Savings |
|---|---|---|
| $10 copayment | $35 for a Brand-name or Preferred formulary drug | $25 per prescription |
| $10 copayment | 50% or $45 minimum for a non-formulary or Non-preferred brand-name drug | At least $35 per prescription |
If you have Standard Option, you can also purchase drugs through the Mail Service Pharmacy Program if your doctor orders more than a 21-day supply of a covered medication, up to a 90-day supply. Your savings when you use generic drugs can be substantial.
| Your Generic Cost | Your Brand-Name Cost | Savings |
|---|---|---|
| First Four Prescriptions each year you pay nothing | $65 copayment for first 30 prescriptions | $65 for first four prescriptions each year |
| $10 copayment for prescriptions after the first four | $65 copayment for first 30 prescriptions | $55 for the remaining prescriptions up to 30 each year |
| $10 copayment for prescriptions after the first four | $50 copayment for prescriptions after the first 30 each year | $40 for the remaining prescriptions after 30 each year |
As you can see from the charts above, you really can save when you use generic drugs. So think about talking to your doctor at your next appointment about what generic medications may be right for you.