September 2008

Saving money with generics

Prescription-drug coverage changes starting Jan. 1, 2009

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Beginning Jan. 1, 2009, there will be two changes to TVA’s prescription-drug coverage for generic drugs. The changes will apply to employees and non-Medicare retirees who are enrolled in the 80 percent preferred-provider organization, Copayment PPO or Consumer-Directed Health Plan only. Medicare Supplement Plan members will not be affected. The changes are the following:

1. You will pay less for a generic drug.

If you are enrolled in the 80 percent or Copayment PPO medical plans, you will pay $10/retail and $20/mail order for your generic prescription drug. The minimum generic drug payment also will decrease to $10/retail and $20/mail order for CDHP medical-plan members. The current amounts for all three medical plans are $12/retail and $24/mail order.

2. You will pay more for using a brand drug if a generic equivalent is available.

If you choose to purchase a brand drug that has a generic equivalent, you will pay your brand copay plus the cost difference between the brand and the generic. This additional cost will apply even if your doctor writes “Dispense as Written” (DAW) on the prescription. Currently, if your doctor indicates DAW, you pay just your copay. Starting Jan. 1, you will pay the copay plus the cost difference regardless of whether the doctor indicates DAW.

Generic Price   Brand Price
Cost $45 Cost $135
Copay $10 Copay
(non-preferred)
$43
Difference in cost N/A Difference in cost $90
Total you pay $10 Total you pay $133

 

It is your choice. If you want the brand drug, you can still get the brand, but you will have to pay the difference. Generics typically cost much less than brands, so they save you money while helping to manage the cost of your health plan. If your doctor says a generic is right for you, ask for a new prescription.

In rare situations, your doctor may decide that a generic equivalent is not appropriate for you due to clinical or therapeutic reasons. If this occurs, you can submit an appeal to the appropriate TVA Healthcare Committee requesting that you not be required to pay the cost difference between the brand and generic. You can submit the appeal before Jan. 1 or any time thereafter. The committee will review your doctor’s information and, based on clinical guidelines, decide if the appeal can be upheld.