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Asking for Generic Prescriptions Is Best

Asking for Generic Prescriptions Is Best

Gregory Gurbikian

President/CEO at Healthcare Solutions Direct, LLC, a nationwide insurance agency focused primarily on the retiree health market.

If we looked at all the prescriptions filled in the U.S., 90 percent are for generic medications. However, brand-name drugs account for 74 percent of drug spending. There is good financial argument in favor of going generic.

Brand-name Medicare Part D drug claims total a little less than what is happening at the national scale for all prescriptions. Only about five percent of all claims are for brand-name drugs but using each opportunity to switch to the generic form can save you money. The numbers do not lie. Even with excellent drug coverage, it is almost always less out-of-pocket for you to opt for a generic medication.

A recent study delved into this issue, noting that if all clinicians traded out brand-name medications for generic options, it could save around $977 million in a single year.

What qualifies as a generic?

The Food and Drug Administration says that generic drugs are the same as brand-name medicines if they meet certain criteria. The generic form of a medication has to equal the brand-name in:

· Dosage form

· Safety

· Strength

· Route of administration

· Quality

· Performance characteristics

· Intended use

Generics also need to use the same active ingredient as their brand-name counterpart and prove to the FDA that their product works the same. The reason we have brand-name and generic medications is all because of patents. When a drug company comes up with a new medication, they patent it. This is what turns into the brand name item. With that patent, they have a window of time where no other companies can manufacture the drug. For this reason, they can set the price point wherever they want. There is no competition. Once that window is up, generics can come in and make the same medication, and usually charge less to compete.

The generic drug stigma

Most often, doctors are the ones requesting a brand-name medication over its generic counterpart, even if a generic exists. This happens about 30 percent of the time, meaning patients are missing opportunities to save money without having to sacrifice the quality of the medicine they are taking.

The reason for this is doubt. Almost half of all clinicians look at generic drugs in a negative light. They question their quality, even though the FDA requires it to be equal to its brand-name counterpart. This is because there are slight differences between the two categories of medication. Generic drugs do not always go through the same rigorous testing. They can also have a 10 percent quantity variation in the amount of the active ingredient. This can lead to inconsistencies in the medication as well as put it at a lower effective rate than that brand-name medications. However, with these potential problems, they often are not enough to pose a high risk. It does help doctors doubt though, creating a stigma against generics.

This doubt passes on to patients who then request brand-name medications as well, just to “be safe.” Patients may also feel like they are saving money when picking a brand name drug since many companies offer rebates or manufacturer discounts. While this will lower out-of-pocket costs, the price may still be higher than the generic form. These discounts also do not last forever, and it is not always possible to flip from a brand name to a generic if you have been on the medication for a long time.

Where medication coverage comes from

Knowing this difference between brand-name and generic medications can help you make more affordable choices, but the real way to save on medications is with the right insurance. For Medicare, that means having a Part D plan. Medicare Part D is required to cover a wide range of the prescription drugs Medicare beneficiaries often take. This also includes medicines in certain protected classes such as those used to treat cancer.

You will not find a master list of what drugs are covered though. Each plan within Medicare Part D is slightly different. Within them, you will often find medication tiers. This is how insurance plans group drugs which is often based on price. Although what medicines are in each tier can vary, it is a given that a Tier 1 medication will generally cost less than a Tier 2 or Tier 3, etc.

Getting right prescription drug plan

Since there are variations between Medicare Part D plans, it is best to work with a knowledgeable insurance agent when selecting what is right for you. They will assess your specific healthcare needs and then make recommendations that help you get the best coverage when it comes to your prescriptions.

They will also help you with all the other parts of Medicare, ensuring you get comprehensive coverage in every area. This is how Healthcare Solutions Direct does it by making sure all your questions about Medicare are answered before you select a plan. Our goal is to get you the right coverage and will work with you from start to finish to accomplish that.

Advocate for the generic

Since rigorous standards label a drug as generic, there is no reason you should not advocate for it with your doctor when encountering a new prescription. Your doctor will also know if a) there even is a generic form available and b) if it will really work for you. Sometimes there are issues with generics. Sometimes your doctor wants the brand name for a particular reason. In these instances, make sure you get an explanation of why a generic option is not right for you.

Your Medicare Part D will only get you so far when it comes to making the right choices in which type of medication you use. Your Medicare insurance agent will ensure that you have the right

plan to accommodate your needs. It is then up to you to limit your own out-of-pocket costs as best you can. To ensure you have the right Medicare Part D coverage, work with an experienced insurance agent, who understands the often-complicated nuances of Medicare. For the best service, contact us today.

Contact Healthcare Solutions Direct to understand your options

Finding the right Medicare plan for your personal needs is essential to maintaining both physical and mental health in an affordable way. While getting the right coverage is important, finding the balance between care and cost is too. Let the insurance experts at Healthcare Solutions Direct help you navigate your Medicare plan options. We represent the major Medicare carriers in the US, allowing us to pinpoint the best choice for you. After pairing you with the right plan, we walk you through the entire process, supporting you the entire way. To learn more, contact us today.

The information provided here is not investment, tax or financial advice. You should consult with a licensed professional for advice concerning your specific situation.

Gregory Gurbikian

President/CEO of Healthcare Solutions Direct, a nationwide insurance agency focused primarily on the retiree health market. Read Gregory Gurbikian’s full executive profile here.

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