Coming benefit changes: Dispense-as-written provision

When the new benefit year goes into effect July 1, employees who have medical coverage through Rice must be aware of three significant changes to previous years’ plans:

• A requirement to have maintenance medication filled in 90-day supplies.
• A dispense-as-written provision.
• Changes to out-of-pocket costs, including a deductible for the POS plan.
  

  Susan Prochazka

Rice News spoke with Susan Prochazka, Rice’s new director of benefits, to explain the changes and will focus on one change each week as the new benefit year begins.

What is the dispense-as-written provision?

Most prescription drug plans include a dispense-as-written provision, and the Rice plan will incorporate a version of this provision starting July 1. It provides that if your physician writes a prescription for a brand-name medication and a generic is available, your prescription will be filled with the generic.

What if I still want the brand-name medication?

If you request a brand-name drug instead of the generic drug, you will be charged both the difference in the actual cost of the generic and brand-name drug as well as the brand-name copay. For example, if a brand-name drug is $100 and a $20 generic drug is available, a plan participant who still requests the brand-name drug will pay the brand-name copayment of $40 ($60 if the drug is nonformulary) plus the $80 difference between the cost of the two drugs — or $120 ($140 for nonformulary) in total for a 30-day supply.

What if my doctor determines that I must have the brand-name medication?

If your physician determines that it is medically necessary for you to use a brand-name drug, he or she can write a prescription that includes the brand name prescribed and the direction to “dispense as written.” You will be able to purchase the drug for the applicable copay with no penalty charge.

What should I do if I currently take a brand-name medication for which a generic equivalent is available?

If you are currently taking a brand-name medication that has a generic equivalent available, you will continue to have access to these drugs but the dispense-as-written penalty will be applied in addition to your copayment. To reduce your out-of-pocket expenses, you should consult with your health care provider to see if you can use a generic alternative. Generic and brand medications must meet the same standards set by the U.S. Food and Drug Administration for safety and effectiveness. If it is medically necessary for you to take the brand-name drug, your physician must indicate “dispense as written” on the prescription, and in this case the brand will be refilled at the brand copay only. This provision is effective July 1, so you should discuss your options with your health care provider now.

Benefits-eligible employees who have questions about Rice’s health and welfare plans can contact the benefits team at benefits@rice.edu or 713-348-2363.