All of our PHP medical plans come with coverage for prescriptions and pharmacy needs. We want our members to get the most out of their healthcare insurance coverage. When understood and used effectively, the pharmacy benefit can save you money on the cost of prescriptions, maximizing your overall benefit.
Brand vs. Generic
Most prescription drugs have two names—one is the brand name that is used for advertising and marketing and the other is the generic name, which usually identifies the chemical ingredients of that particular medication.
Although a prescription drug may have a generic name, that does not necessarily mean that a generic drug is available. New drugs are patent-protected for twenty years after they are discovered and, during this time, no generic may be sold for the drug. After the patent expires, however, the FDA allows other companies to manufacture equivalent versions of the drug, which are then sold at a discounted price (sometimes 30% or even 50% less than the original brand name drug).
In order for the generic drug to pass FDA standards, it must supply the same amount of active ingredient absorbed at the same rate as the original drug. It must also be of the same strength, have the same effect, and be of the same dosage form as the original.
There can be a few minor differences between a generic and a brand name drug. These include colorings, fillers, and flavors. These are aspects that could cause a subtle difference in how the patient experiences the drug. Although the difference is usually slight, it's important to ask a doctor about the differences between the brand name and generic forms of the drug he/she intends to prescribe.
Regardless of the form, rest assured that the FDA requires generic drugs to perform in the same way as their brand name counterparts and all pharmaceuticals available in the United States undergo very strict review.
What if a brand name prescription is prescribed and only the generic is covered?
If a brand name medication is required instead of a generic medication, the pharmacy will only dispense the generic medication if signed "may substitute" by the doctor on the prescription. If a brand name medication is prescribed and the prescription is signed "dispense as written" the pharmacist cannot legally change the doctor's orders and a member will be charged the prescription co-pay plus the cost difference between the generic and brand name medications.
What is step therapy?
Step therapy means that some drugs require the use of an appropriate alternative therapy by the patient within a specified number of days before the drug in question can be covered by the plan.
What is a specialty drug?
Specialty drugs are generally injectable, high-cost medications that have special handling requirements or require special training before use.
Is a mail order program available?
Yes, a mail order program is available. Contact PHP Customer Service for more details.