If a member has a medical intolerance of a generic equivalent of a brand name drug, will the member still be required to pay the $25 copayment?
In the event that a member is unable to take the generic equivalent of a brand medication due to a therapeutic failure or intolerance to the generic equivalent, the member will be able to receive the brand name drug. This will require that the members physician obtain prior authorization for the brand medication based on the failure or intolerance to the generic equivalent. If the physicians request for the use of the brand name drug is approved, the member will receive the brand name drug and will only be required to pay the brand copayment. The physician is to obtain an authorization form from Caremark that is to be completed and returned to them for approval.
Related Questions
- A non-preferred drug is a medication that has been determined to have an alternative drug available that is clinically equivalent. If I am taking a brand name drug when a generic equivalent is available, at what co-payment level will this drug be available?
- If a member has a medical intolerance of a generic equivalent of a brand name drug, will the member still be required to pay the $25 copayment?
- Is the generic equivalent as strong as the corresponding brand name drug and does it work as fast?
