Question: What recourse do I have if my insurer will cover only a generic version of a prescribed drug?
Answer:
To help ensure that you receive the brand-name version of the drugs prescribed to you, ask your physician to mark your prescriptions "DAW" (dispense as written). Your physician should do this anyway if a drug's generic equivalent is not appropriate for your condition. Otherwise, your pharmacist may be required to fill your prescription with a generic equivalent. But your insurer may not allow you to get brand-name drugs in every instance, depending on the terms of your health plan.
To deal with the rising cost of prescription medications, health insurers encourage providers to substitute many brand-name drugs with their generic equivalents. Although you may sometimes get the brand names by paying a higher co-payment, some health-care plans offer coverage only for generic drugs. If this is the case with your insurer, you may have to pay out of your own pocket if you want a brand-name drug. But speak with your primary care physician. If you have a condition that medically warrants the use of a brand-name medication that is not covered under your prescription plan, your doctor can petition your insurer for special coverage as a matter of medical necessity.
Remember that both brand-name and generic medications are approved by the U.S. Food and Drug Administration. In nearly all instances, the generic equivalent of a particular medication is an appropriate and less expensive substitute for the brand-name version.
Prepared by Broadridge Advisor Solutions Copyright 2022.