I'm trying to get a prescription for a name-brand drug since the generic I am taking now doesn't seem to work as I'd like. I'm not happy with some of the side effects and really would like to try the name-brand. Two questions.
First, is there any kind of ways to get exceptions made with an HMO or is it a simple covered or not covered type of thing?
Second, does anyone know of any HMO's that offer more coverage for name brands drugs? My employer offers a few options, but it's tough to tell which particular drugs they cover. I'm in the MA area if it helps.
My mom has found reactions to some generics that she doesn't have in brand names. For that reason her doctor writes the scripts for brand as "medically necessary" and that has worked for her.
From what I've read on another forum, generics (or at least a specific one) between the manufacturers of generics, ingredients are similar and the potency is similar but if you compare brand to generic it is sometimes 20-30 percent less effective for generic. I don't know how true that is, I would talk to a pharmacist for that information as I don't know the qualifications of the poster who posted that. From what I understand about generic and brand, they are identical except the generic may have "fillers" that the brand doesn't have. But again, I'd check with a pharmacist.
Also, I know my last two healthplans (although they were ppo) had a drug list on their website that had covered drugs, brand and generic, and their costs.
Thanks for the replies. I'm going to check with the pharmacist to see if they are indeed any different. I've already spoken to my doctor about this, so I think the "medically necessary" route might be a dead end for me. We'll see what happens. For all I know, the name brand will have the same side effects.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.