Can someone explain to me how a company/insurer can mandate that only generic cost be covered, even if a physician prescribes brand name only? husband's company is changing benefits come April 1 so that if we insist on brand name medications, we are responsible for the difference in cost between the generic and brand name, plus the copay. Doesn't matter if MD prescribes brand name or not - they will only pay nongeneric cost. This in essence will make us uninsured as far as Boo's medications are concerned. Our out of pocket cost will be $20,000 per year. Not something we can afford by any stretch of the imagination.
What gets me is that generics are *not* identical to brand name. It took years to get his epilepsy under control. He's on 3 medications right now, plus the prn one we use when he does seize (I didn't even check the cost difference on that one). And yet I've got bureaucrats/accountants telling me that in order to keep from going bankrupt, we must give him generics. They don't care about seizure control. They sure as heck don't care if he starts having breakthroughs or the expense of that (last seizure cost over $10,000, just for 1 night in the hospital). The older he gets, the more anxious I am about seizure control. I'm terrified of SUDEP, and terrified that if he does start having breakthroughs if we do switch to generics, we will never get them under control again.
How can they get away with dispensing medication *not* as written?
What gets me is that generics are *not* identical to brand name. It took years to get his epilepsy under control. He's on 3 medications right now, plus the prn one we use when he does seize (I didn't even check the cost difference on that one). And yet I've got bureaucrats/accountants telling me that in order to keep from going bankrupt, we must give him generics. They don't care about seizure control. They sure as heck don't care if he starts having breakthroughs or the expense of that (last seizure cost over $10,000, just for 1 night in the hospital). The older he gets, the more anxious I am about seizure control. I'm terrified of SUDEP, and terrified that if he does start having breakthroughs if we do switch to generics, we will never get them under control again.
How can they get away with dispensing medication *not* as written?