Prescription Brand Deductible and Generic Substitution
If you are a Member of the Premier, Basic or the MILA
Medicare Wrap-Around Plan, you will pay a $500 family
deductible for all brand name drugs when a generic equivalent
is available (“multi-source brand drug”) and the prescribing
physician directs that only the brand may be issued
(either by indicating “Dispense As Written” [DAW] or
otherwise). These brand name drugs are sometimes called
multi-source brand drugs. However, if the prescribing
physician provides a written statement which is satisfactory
to MILA that you cannot take the generic drug for medical
reasons unique to your situation, the multi-source brand
drug will be issued and the deductible will be waived for
that prescription.
If the prescribing physician has not marked the multisource
brand drug as DAW, the Plan requires that the
pharmacist substitute the generic drug for the brand name
drug to which it is equivalent when the prescription is
filled. You will save money because you will be charged the
generic copay instead of the brand copay. However, if you
insist on the multi-source brand drug being issued, you will
be charged the generic copay plus the excess cost of the
multi-source brand drug; the Plan will pay only what it
would have paid if the generic had been substituted.
After your family meets the deductible amount for
multi-source brand drugs for the year, you pay the copay
amount shown in the Premier, Basic or MILA Medicare
Wrap-Around Plan Summary Chart. The copay amount
depends on the type of drug you purchase and whether
you purchase it from a retail pharmacy or the mail service
pharmacy. This deductible is applied to all multi-source
brand drug prescriptions filled at a retail pharmacy or at
the Caremark® Mail Service Pharmacy. It does not apply if
you fill a prescription for a generic drug or a brand name
drug for which there is no generic equivalent drug.
