Why Didn’t I Know There Was A Generic Version

I got this question e-mailed to me today.  The patient has been using the same drug for years and it lost it’s patent about 6 months ago.  They just found out that they could have saved a lot of money and wondered who should have told them.  Here’s my thoughts.

1. It’s the member’s responsibility ultimately to search for ways to save money and ask for generics.
2. A lot of managed care companies and PBMs won’t reach out when patents expire because 90% of the time the drug is switched to the generic within 90-days by the pharmacy.
3. The key players who would communicate are aligned – the pharmacy / PBM makes more money when generics are used and the managed care plan saves more money.
4. BUT, sometimes managed care plans or individual employers (groups) will opt-out or never sign up for communication programs so their members don’t hear about ways to save money.
5. BUT, sometimes consumers opt-out of communications from the PBM or managed care company and therefore miss out on opportunities.
6. BUT, sometimes physicians won’t allow the prescription to be switched to the generic drug (even when chemically equivalent) and will write the prescription DAW (Dispense As Written) or say no substitution allowed.
7. BUT, there have been a few instances when due to exclusivity on the generic that it actually costs more than the brand during the initial 6-months and people don’t move to the generic.

So, with lots of nuances, my reply was that no one had a legal obligation to tell her, but they all had good incentives to do it.  I suggest talking to the physician and/or the pharmacist.