Transcript SPAP Chartbook Updated - The Commonwealth Fund

Rizzo, Fox, Trail, and Crystal, State Pharmacy Assistance Programs: A Chartbook—Updated and Revised, January 2007
States with Generic Substitution Requirement, 2003
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As a cost-containment measure, states may require generic substitution of a brand-name medication, if a generic
alternative is available. Generic medications are typically much less expensive than brand-name medications.
However, rebates collected for generic medications are lower.
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The MMA regulations encourage Prescription Drug Plans to employ generic substitution as a cost
containment measure.
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Fifteen of 22 states required mandatory generic substitution.
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In five of these states, prior authorization was needed for the patient to receive the brand-name drug.
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In eight of these states, physicians could override the mandatory generic substitution by noting on the prescription
that the brand is medically necessary.
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In Pennsylvania, the card holder was required to pay the copayment plus 70% of the average wholesale price of
the brand-name drug.
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In Wyoming, the state paid the generic price of the drug and the enrollee was responsible for the balance.
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