IQVIA Benefits Handbook
ANSWERS TO FREQUENTLY ASKED QUESTIONS
Am I required to use a generic drug?
The Express Scripts or Kaiser network pharmacy will always dispense an available generic medication unless otherwise indicated by the prescriber or the member.
With Express Scripts, if you choose the brand-name drug where a generic exists, you must pay the difference between the brand and generic in addition to your copayment.
Will I pay the brand-name copay/coinsurance if there is not a generic alternative for my prescription?
Yes, that is correct.
Am I required to use mail order for maintenance medications?
After the first two 30-day fills of a maintenance medication at a retail pharmacy, you are required to fill any subsequent fills of those maintenance medication prescriptions with 90-day fills through Express Scripts mail order or through a CVS retail pharmacy if you have Express Scripts) in order to receive coverage.
Am I required to use the Express Scripts mail order specialty care pharmacy for specialty medications?
Yes, after the first two 30-day fills of a specialty medication at a retail pharmacy, you are required to fill any subsequent prescriptions through Express Scripts Exclusive Specialty pharmacy, Accredo, in order to receive coverage.
What is the difference between generic and brand-name drugs?
The main difference is cost. The generic name of a brand-name drug is its active chemical name. The brand name is the trade name under which it is advertised or sold.
By law, generic and brand name drugs must meet the same standards for safety, purity, strength and effectiveness. When authorized by your doctor and permitted by law, a pharmacy is able to dispense a generic drug when one is available. This saves you money. When you need a prescription drug, ask your doctor whether a generic can be substituted for a brand name drug.
What do I do if I need to refill a medication early because I am going out of town?
Depending on the length of your trip, you may qualify for a vacation override for some medications.