Q: Why are certain drugs not covered or included in the formulary?
A: There are many different reasons that your health insurance provider may decide to exclude a drug from their formulary, or offer a tiered program to encourage cost savings.
Lifestyle – Medications that are not vital to maintain health, instead are medications that may provide improved lifestyle (for example: Viagra, Retin-A)
Price Comparisons – We try to manage your healthcare dollars the same way that you manage your household budget. We review literature and discuss among our Medical Management and Pharmacy and Therapeutics Committees which medications are the most cost effective. Our decisions on the formulary should help you to get the most from your healthcare dollars.
Side Effects
Efficacy – This is the effectiveness of a drug based on research and statistics. It is the most important part of selecting a drug for our formulary.
Rebates – These are only taken into account when all things being equal (meaning the medications in the category are equally effective) and cost is an issue. Rebates (from pharmaceutical companies) help reduce the cost of your overall healthcare costs.
Cost Effective – It is the goal of our medical review committee to use expert knowledge to determine comparisons of medications in related fields to determine value for the healthcare dollar spent.
To save YOU money – By not covering similar drugs, the market is shifted to a more effective drug that may be less expensive and/or results in rebates, thereby reducing or maintaining premium costs to you.
Q: Why should I choose a generic drug?
A: Generic medications are widely accepted by doctors and pharmacists. Already, more than 40% of all medications dispensed each year are generic drugs. And the number of generic drugs is constantly increasing. By 2006, many of the best-selling, most widely prescribed brand-name drugs will become available as generic medications for common medical conditions, including heartburn, allergies, depression and high blood pressure.
Q: Why do generic drugs cost less than brand-name drugs?
A: Drug manufacturers spend large sums of money on the research, development, marketing and advertising of brand-name drugs. Manufacturers of generics have lower costs - and they pass the savings on to you.
Q: Are generic and brand-name drugs the same?
A: A generic drug contains the same active ingredients in the same dosage forms and strengths as the brand-name drug. That means generic drugs can be used by patients of all ages to achieve the same medical effects of brand-name drugs.
Q: Why should I choose a generic drug?
A: By choosing a generic medication, you can save money on your medication co-pay. You get the same quality and effectiveness as a brand-name drug and also help keep the healthcare costs more affordable to everyone.
Q: How do you know generic drugs are safe?
A: The U.S. Food and Drug Administration (FDA) approve both brand name and generic drugs before they are marketed in the United States. The FDA requires that generic drugs contain the same “active” ingredients as brand-name drugs and be used in the body in the same way. This ensures that generic drugs are as safe and effective as brand-name drugs.
Q: How do I choose a generic drug?
A: When you get a prescription, find out whether a generic drug is available and whether it is right for you. Ask your doctor or pharmacist: Is there a generic drug that is appropriate for my condition? What is the potential for any side effects if I change medications?
Q: What if I have more questions about generic drugs?
A: Read the FDA’s Questions and Answers on line at http://www.fda.gov/cder/consumerinfo/generics_q&a.htm.
Q: Do you have Pharmacy Questions? Have you ever wondered if you are taking your medications in the right way? Do you understand what your medications are for and what the benefits and risks are associated with taking them? Are you sure about the over-the-counter or herbal medications that you take and whether or not they are safe to take with your prescription drugs? What about the cost of your medications - are you on the most cost-effective regimen appropriate for you?
A: Lewis Drug can answer your questions. Make an appointment for a medication review with a member of their pharmacy team. This is a free service provided by Lewis Drug and SDSU College of Pharmacy. All information is held confidential. Allow approximately one hour per consultation. Make an appointment by calling Heather at (605) 367-2678. Lewis Drug can help manage your health.
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