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Name Brand Prescriptions with an HMO
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Name Brand Prescriptions with an HMO

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.

Thanks.
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3 Comments
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Avatar_f_tn

I would first check with your pharmacist to see if your generic drug has the same ingredients as the brand name drug. Usually... the medications are exactly the same.
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Avatar_n_tn
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.

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Avatar_n_tn
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.

chutes
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