A generic drug is a chemical equivalent of a corresponding brand-name drug. The US Food and Drug Administration sets quality standards for generic drugs to ensure that these drugs meet the same standards of quality and strength as brand-name drugs.
Generic drugs are generally less expensive than brand drugs. Therefore, you may reduce your out-of-pocket-expenses by choosing to use a generic drug.
High Option prescription benefits
With the High Option prescription plan, a generic equivalent will be dispensed if it is available, unless your prescriber specifically requires a brand-name drug. If you receive a brand-name drug when an FDA-approved generic drug is available, and your prescriber has not received a preauthorization, you have to pay the difference in cost between the brand-name drug and the generic, in addition to your coinsurance.
However, if your doctor obtains preauthorization because it is medically necessary that a brand-name drug be dispensed, you will not be required to pay this cost difference.
Your doctor may seek preauthorization by calling 1-800-753-2851.
High Option coverage limitations
The Plan may have certain coverage limitations to ensure clinical appropriateness. For example, prescription drugs used for cosmetic purposes may not be covered, a medication might be limited to a certain amount (such as the number of pills or total dosage) within a specific time period, or require authorization to confirm clinical use based on FDA labeling.
In these cases, you or your prescriber can begin the coverage review process by calling Express Scripts customer service at 1-800-841-2734.