Q: My brand name drug is supposed to go generic this year. Will my drug plan cover the generic and if so will I be notified?
A: Sixteen major brand name drugs are going generic this year and another 25 are in the generic pipeline for 2014. Generic drugs can provide a savings of about 30-80% on the cost of your prescription when compared to brand pricing. But it could take up to a year or more before you and your health plan see substantial savings.
Before a company's drug patent expires, manufacturers of generics race to file lawsuits to challenge the patent. The company that wins gets a six-month period of exclusive sales to sell the drug. While this doesn't always happen, when it does it can delay real market competition until several manufacturers start making the generic version.
Call your drug plan to ask about the coverage of the new generic and the expected co-pay. Be forewarned: according to Consumer Reports magazine, some Medicare drug plans charge lower co-payments for the branded version than for its generic counterpart. That has to do with agreements between insurers and pharmaceutical companies that make it seem like the name brand is the better deal.
Consumer Reports makes a good point. When you stick with the higher costing brand, the entire cost of the drug under that plan will apply towards your initial coverage limit, pushing you toward the doughnut hole coverage gap. That raises the chance you will use up your limit before the year's end and you’ll pay half the cost of the brand name drug in the doughnut hole, and 79% on any generics. You may want to ask your doctor to prescribe the generic version of the drug whenever available.
Plan to compare your drug plan options during the fall Open Enrollment Period that starts October 15th and runs through December 7th. Chances are you will find a much lower-costing plan that will save you a bundle in 2014 if you switch plans.
The pharmacy benefit management company Express Scripts/Medco has one of the most comprehensive lists of the estimated dates in which brand drugs patents are ending. To learn more about your drug plan options, visit www.Medicare.gov and look on the homepage for the link to "Compare health and drug plans."
Source: "New Generic Drugs Can Save You Money," Consumer Reports magazine, May 2012.