How do most plans handle new generics?

[andrew.maiorini]

I have a question about new generic releases. It seems there are occaisonal supply issues surrounding new generic products (in "mandatory generic" plans only) during the first few months of a new release. For example with the recent release of ropinirole (generic Requip) do plans automatically allow for a time period where the brand will still process? If so, how long?

[chantell.reagan]

In my experience, generally, new generics with supply issues are handled on a case by case basis for mandatory generic plans. For example if there was a noted shortage, as with ropinirole, a one-month approval would be given for members to continue receiving the brand with no penalty. Before the end of the next month, the plan would check the supply shortage w/ local pharmacies and make a determination as to whether to extend the authorization.

[participant1]

Just to weigh in from the perspective of commercial plans with a typical 3-tier formulary: this is typically not an issue. Many commercial plans have contractual obligations to advise members of formulary changes in writing within 60-90 days, which usually takes care of supply issues with the 1st generic.

[Nochmar]

I think most third parties rely on a information company like MediSpan to tell them when something is officially a generic and which ones are still considered branded; in many cases the certificate is written to support that. There are times when a "generic" is launched that it is still considered a branded product; this is happening now with sumatriptan by Dr. Reddy.

For the regular generic launches, we don't mandate generics until we are certain that the market has adequate supplies on hand. In cases where supplies are limited, we allow generic (generic copay) or brand (brand copay) for 60-90 days or for whatever the supply issues are expected to last. After this time elapses, we review the situation.

Something for the chain people to consider is allowing their stores the ability to adjust the DAW or PSC codes they use on their claims for a few months after a new generic is launched, too. Many chains limit the PSC codes available for most medications in an effort to keep it simple for their employees and avoid foolish errors; however, if ropinirole is unavailable and the chain stores can only submit Requip with a PSC code of 1 or 2; there will be plenty of problems for the pharmacies and patients.