Issue link: http://cp.revolio.com/i/1520
May/Jun 2009 | www.MyFamilyDoctorMag.com | 13 Generics and the Government Many Medicare part d and Medicaid programs require generics, says doug Hoey, r.p.H., chief operating officer of the national community pharmacists association. "Most plans that i've seen do have some exception rule. However, finding a physician willing to go through the paperwork for free … is challenging." When shopping around for a part d plan each year, he suggests, "look at the different plans and see how they treat brand drugs." "I'll scratch your back …" Generics, pharmacies and profits Say your doctor writes a prescription for a brand-name drug, but when you get to the pharmacy, you find that your insurance won't cover it. Perhaps you should ask your friendly pharmacist whether the generic would be as good. That's fine. Just know that your pharmacist may be getting a bonus on said generic. "I wouldn't want to portray it as widespread, but there are a few [insurance] plans that give the pharma- cist an incentive to dispense generic prescriptions," says Doug Hoey, R.P.H., chief operating officer of the Na- tional Community Pharmacists Association, which rep- resents independent pharmacies. And there's a reverse penalty "that they'll pay the pharmacy less if they don't dispense a certain percentage" of generics. Then there's your doctor. "I've seen letters sent to physicians from insurance companies saying, 'You're prescribing too many high-cost drugs. Stop it, or we'll drop you out of our network,'" says Hoey. Most of the time, all this isn't a practical concern when it comes to getting your prescription filled. Ge- nerics are fine and benefit you, too, since you're saving money. But, as this article mentions, there are exceptions to this rule. If your doctor writes a prescription for a brand- name medicine, "Always ask, 'Is there a generic avail- able?'" recommends Dennis Bryan, R.Ph., M.B.A., F.A.Ph.A., a pharmacist with WBC Pharmacies in Chi- cago. But, he says, also ask, "Would you give the generic to a family member?" and, "Would you use the generic yourself ?" cision-making process, it's not the only one. Other factors, like side effects, resistance (in the case of antibiotics), other medications you're taking, allergies, other health problems you have, and how likely it is that you can properly adhere to the treatment are just a few of the things your doctor must consider. "Is there a generic you can write?" is a question pa- tients increasingly ask. The answer is often, "Yes." Occa- sionally, though, the generic option is simply not the best for the particular case at hand. In the end, the one person—besides you, of course— who is most likely to want you to recover as quickly, pain- lessly and inexpensively as possible is your doctor. Talk to him or her about your cost concerns. Your doctor is likely to be your best advocate in an ever-changing and finan- cially challenging time. Matthew n. PaRkeR, M.d. is an urgent care and family medicine physician in Hoover, Ala. BRAnD VERSuS GEnERIC Similar questions could apply when your insurance company covers a different brand than the one your doctor prescribed. Some pharmacy benefit managers— the organizations that run insurance companies' pre- scription plans— have agreements with certain phar- maceutical manu- facturers. The PBMs get discounts based on how much of the brand their members buy. "This helps lower the cost of the drugs for the plan, and ultimately the con- sumer," says Megan Schiavone, a spokeswoman for the PBM Medco. But just like generics, brands differ and may not be appropriate for everyone. Perhaps the key is, "Find a pharmacy that you can trust," says Carl Labbe, R.Ph., a Walgreens pharmacist at Banner Desert Medical Center in Mesa, Ariz. Find a doctor you can trust, too. Put together a good team who will answer your questions honestly, and you've got a great chance of both saving money and getting the best treatment.