The Mandatory Generic Program encourages the use of affordable, effective generic drugs. If a member chooses to purchase a brand drug that is available in generic form, the member is responsible for paying the dispensing pharmacy the difference between the negotiated discount price for the generic drug and the brand drug, plus the appropriate cost-sharing for a brand drug.
||$260 (Discounted cost of brand - discounted cost of generic + copay)
The formulary is designed to include all therapeutic categories and provide physicians with prescribing options. Drugs designated as non-formulary are not covered. Non-formulary drugs have covered equivalents and/or alternatives used to treat the same condition in a more cost-effective manner. Physicians may request coverage of a non-formulary drug by submitting a medical necessity request. Visit ibx.com/formularyexceptionspolicy for details about the formulary exception process.
Note: If a member’s prescription drug benefit includes the mandatory generic benefit and the formulary exception is approved for a brand drug that has a generic equivalent, the member will be responsible for paying the dispensing pharmacy the difference between the negotiated discount prices for the generic drug and the brand drug, plus the appropriate member cost-sharing for a brand drug.