Refills allowed as prescribed (Best option for maintenance medication) $20 $75 $112.50 Generic Drugs are medications sold under a standard name that by law must have the same active ingredients and are subject to the same U.S. Food and Drug Administration (FDA) standards for quality, strength and purity as their brand name counterpart. Generic drugs usually cost less than brand name drugs. Preferred Drugs are a list of brand name medications preferred for their clinical effectiveness and opportunities to help contain participant and plan costs. The list of preferred medications is available on the Medco website (listed at the end of this section). Non-Preferred Drugs are brand name medications that are not on the Preferred Drug list because there are effective and less expensive alternatives available. These medications require the highest copayments. If you choose to purchase a Brand Name Drug when there is a less expensive Generic alternative, you must pay the difference between the cost of the Brand Name drug and the Generic drug plus the applicable Generic Copayment . This difference does NOT count toward your $50 annual deductible per person per plan year. Sometimes the cost difference is quite large. Below is an example of how this type of claim would process if you had already met your $50 annual deductible: Cost of Brand Name Drug $150 Less Cost of Generic Equivalent - $55 Plus Cost of Generic Copayment + $20 Your Payment $115 The UT SELECT Prescription Drug Plan administered by Medco also offers a small benefit for Out-of- Network pharmacies. You will pay the full cost of your prescription and send a claim form and your receipt to Medco. Your reimbursement will be based on your total cost, minus the UT discount, the applicable annual deductible and copayment. You will be responsible for the amount above the UT contracted rate. To help you make the most of your prescription benefit program, UT SELECT provides you and your family the generic substitution program. Generic substitution is the process of substituting the lower cost generic equivalent drug in place of the more expensive brand name medication. Generic substitution is encouraged by pharmacists, plan sponsors, and is provided for by Texas State Law to lower prescription drug costs. The State of Texas has strict guidelines that govern generic substitution. A pharmacist may substitute a prescription issued by a prescriber if the generic
Group Insurance Benefits Plan Information 26 product costs the patient less than the prescribed drug product, the patient does not refuse the substitu- tion, and the prescriber does not prohibit substitution. For written prescriptions, a pharmacist may substitute a generically equivalent drug for the brand prescribed unless the prescriber writes in his/her own handwrit- ing the words “Brand Necessary” or “Brand Medically Necessary” on the face of the prescription. For verbal prescriptions, the prescriber or agent may prohibit substitution by specifying “brand necessary” or “brand medically necessary.” The pharmacists must note any
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