- Participating Physician Groups (PPG)
(does not apply to HSP)
A generic-equivalent medication is the pharmaceutical equivalent of a brand-name medication for which the brand-name medication's patent has expired. The Food and Drug Administration (FDA) must approve the generic medication as meeting the same standards of safety, purity, strength, and effectiveness as the brand-name medication.
Generic Substitution Program
If a generic product cannot be used due to medical necessity, a prescriber may:
- Clearly indicate on the prescription "do not substitute" (DNS) or "dispense as written" (DAW). The pharmacist must make the indication on the prescription claim, and the member may be charged the higher copayment, or
- Request prior authorization for the brand-name medication documenting failure or clinically significant adverse effects to the generic equivalent.