Health Plan Changes

4.  Generics Preferred Program

Effective July 1, 2009, the University's prescription drug plan will implement a "generics preferred" program.  After that date, when employees or family members need a new prescription or a refill for a brand-name drug, the pharmacist will check whether a generic drug is available instead. If a generic is available, employees are encouraged to utilize the generic option. If the employee chooses to use the brand-name instead of the generic, the employee will be charged the full cost difference between the generic and the brand-name drug.  If there is no generic available, the employee will be charged the normal brand name copay.

Generic drugs are copies of brand-name drugs whose patents have run out.  That is, a generic drug has the same chemical makeup as the original brand-name drug.  Generics account for more than 45% of all medications prescribed in the U.S. More people are choosing them because they are:

• safe – generics have the same active ingredients and are used in the body the same way as their original brand-name drugs. They're also approved by the U.S. Food and Drug Administration (FDA), just like brand-name drugs.
• effective – generics are just as strong and deliver the same medical benefits as the brand-name drugs.
• less expensive – generics are not advertised like brand names, and they cost less to produce, so the savings are passed along to you in the form of a lower co-payment.

• Generic:                                    $10 retail;  $15 mail order
• Brand Name if Generic                  Full cost difference between Brand Name
  Available and Not Used:               and Generic Drug.
• Brand Name if No Generic             
  Available:                                  $20 retail;  $30 mail order
  
• Non-Formulary Drug:                   $30 retail;  $45 mail order

If an employee or family member is allergic to a drug, or their physician requires that a brand name be utilized, the employee and physician can apply for a waiver to the Generics Preferred Program. The physician must submit a detailed letter describing the reasons the brand name drug must be utilized.  Express Scripts will review the appeal letter and determine whether the Generics Preferred Program can be waived.  If a waiver is granted, the $20 retail ($30 mail order) copay will be applied.

formulary
The following are links to the Express Scripts formulary listing. These lists are not all-inclusive and do not guarantee coverage. In addition to using this list, you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate. 

• 2009 Express Scripts National Preferred Formulary- most commonly prescribed drugs (2 pages)
• 2009 Express Scripts National Preferred Formulary (18 pages)