Generic Substitution

Generic substitution means your plan reimburses prescription drugs based on the cost of the lowest-priced equivalent generic medication rather than the brand-name drug, unless a doctor indicates “no substitution” for medical reasons.

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This approach keeps premiums affordable and encourages cost-effective healthcare. Generic drugs contain the same active ingredients and meet the same quality standards as brand-name versions but are usually much less expensive.

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Example:

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If a brand-name drug costs $80 and its generic version costs $35, your plan reimburses based on the $35 price unless your doctor specifies medical necessity for the brand.

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What to Watch For:

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Check if your plan requires prior authorization to cover brand-name drugs. Pharmacies may automatically substitute generics unless your doctor marks “no substitution.”