If I buy a brand-name drug, do I just pay the formulary or nonformulary copayment?
That depends. If no generic equivalent is available, you pay the formulary copayment if you buy a brand-name drug on the formulary and the nonformulary copayment if you buy a brand-name drug not on the formulary. However, many plans have mandatory generic substitution. If a generic is available, many plans require that you pay more if you do not want to take the available generic. If you are covered by one of the A&M Care plans, your doctor can submit medical evidence that you need the brand-name drug because you can’t take the generic drug, and Medco, the A&M Care drug plan administrator, may approve payment of the brand-name formulary or nonformulary copayment.
Related Questions
- What if an employee is taking a brand-name drug that does not have a generic equivalent? Will BCBSNC waive the brand-name drug copayment since there is no generic equivalent?
- If my doctor submits evidence that I must have a drug not on the formulary list for medical reasons, can I get the nonformulary drug by paying the formulary copayment?
- What is the difference between a formulary, generic, brand-name and non-formulary drug?
