Can I control which generic med I'm given?
November 16, 2017 8:09 AM   Subscribe

I've been getting a generic medication from the same CVS for a couple years, but just moved to NYC. When I picked up the prescription from my new CVS, the copay was about $30 more than usual. I got home and realized that this generic looked totally different and was by a different manufacturer than my old one; I'm assuming this is why it cost more. How do I switch back to the old generic?

More specifically: The medication is lamotrigine XR, and my old generic didn't list any kind of manufacturer and came in a normal orange pill bottle. The new one is in a special bottle from a manufacturer called Dr. Reddy's.

Can I bring in my old bottle with the description of the previous generic written on it and request that my CVS order that one for me, or are they locked into only ordering one kind? Are what manufacturers the pharmacy orders from decided on a store-by-store basis, city-by-city basis, etc.? Do I need to shop around at other pharmacies and ask which generic they stock? Has anyone experienced this before or am I totally off in assuming that the different manufacturer might have changed the cost and it's probably a coincidence that the two things changed at the same time? I can swallow the extra expense if necessary, but I'd really rather not if at all possible.
posted by Lady Gotohell to Health & Fitness (14 answers total) 1 user marked this as a favorite
Your copay is determined by your insurance company, not by the drug manufacturer.

If you have a different job or a different insurance plan than you had before you moved to NYC, that will be the explanation — your new plan has higher copays, either in general or for this specific drug.
posted by nebulawindphone at 8:20 AM on November 16, 2017 [4 favorites]

What nebulawindphone says, and if it is a maintenance medication (ie something you take 1 pill a day, every day forever, or until doc says not needed), your insurer may require mail-order (90 day) supplies, and the insurer will ding you if you go to the retail counter and only get a 30-day supply.
posted by k5.user at 8:36 AM on November 16, 2017 [2 favorites]

Oh, good point, yeah.

What you might do is call your insurance company. There should be a phone number on your insurance card — if you have a separate card for prescription coverage, use the number on that one. Or, if you can't get a phone number that way, ask HR where you work. Say you want to talk to someone about prescription benefits.

When you get someone on the phone, explain the situation and ask if there's anything you can do to get a lower copay. There might be a mail-order option like k5 says, they might want your doctor to get in touch and say "Yeah, we tried XYZ cheaper meds, they didn't work, that's why we need her to take this expensive one," there might be some other hoop to jump through. But talking to a human at your specific insurance company will probably steer you in the right direction.
posted by nebulawindphone at 8:53 AM on November 16, 2017

Thanks to anyone who's answered already, but to clarify, nothing has changed about my insurance plan; I'm on my dad's insurance right now, so it's unaffected by changes in my life, and I've never been required to order a 90 day supply before. My assumption was that the insurance company is setting a different copay for the different version of the generic, not that the manufacturer is setting it.

I'll try talking to someone at the insurance company, but in case that doesn't solve it, I would still like to know if anyone is aware of a way to control which generic I receive.
posted by Lady Gotohell at 9:21 AM on November 16, 2017

Your copay is determined by your insurance company, not by the drug manufacturer.

Not necessarily. If your copay is a percentage, different brands of generics could have a different price.

Are what manufacturers the pharmacy orders from decided on a store-by-store basis, city-by-city basis, etc.? Do I need to shop around at other pharmacies and ask which generic they stock?

Pretty much. The first step would be finding out who the old manufacturer is. On CVS prescription labels, it's printed in the lower left corner, underneath the box with the pill description in it. Your new CVS may be able to special order it for you.
posted by neckro23 at 9:23 AM on November 16, 2017 [1 favorite]

This happened to me recently with sertraline - the price was the same but the manufacturer and shape of the pill were different. I asked the pharmacist if he could order me the previous manufacturer's supply, because I have trouble swallowing pills and I liked the old shape better, and he told me their factory was in Puerto Rico and he wasn't sure if/when they would be able to get it back in stock. I ended up being fine with the new shape but if it didn't work for me I was planning on going to different pharmacies with the previous manufacturer information and asking for that specific one.
posted by tatiana wishbone at 9:25 AM on November 16, 2017 [2 favorites]

Well, still, the first place you should be looking is your insurance. The basis for determining your co-pay should be readily available. Most (but not, as noted, all) prescription drug coverage tiers drugs, with all generics ordinarily being Tier 1, lowest cost. So the cost should be the same regardless of manufacturer.

If your copay is a percentage, a $30 swing is still huge--say your percentage is only 10%, that suggests a $300 price difference. That's an extraordinary difference among generics, which compete primarily on price.

Assuming the calculations are correct: The market is complicated but ultimately the chain is going to decide where to order from. CVS is probably not going to change its manufacturer for you. So, I guess there's no harm in asking, but you should be looking at other drugstores.
posted by praemunire at 9:42 AM on November 16, 2017 [1 favorite]

You can check a different pharmacy chain, but I would guess you won't have much luck getting a pharmacy to special order for you

This has only happened to me once, and it turned out that the manufacturer I liked had stopped making my medication, so I was completely out of luck.
posted by ktkt at 10:51 AM on November 16, 2017

I agree with everyone else, start by contacting your insurance. Call them and ask why the copay for the last refill was different from all the previous ones.

If somehow it does turn out to be related to the manufacturer, it is totally possible to get generic medications from a specific manufacturer, though the amount of effort required may vary.
posted by yeahlikethat at 11:17 AM on November 16, 2017

I've been able to get my pharmacy to order the particular generic I prefer. What works best is getting my doctor to write "brand necessary" on the prescription and specify that particular manufacturer. Before I got her to do that, my regular pharmacy would order the brand I liked, but when I was at another branch of the same pharmacy out of state, they were not willing to order the right brand for me. Being a regular customer apparently helped.

Getting the brand I like is a matter of its being more effective for me, though. I'm pretty sure it did not get me a better copay.
posted by artistic verisimilitude at 12:03 PM on November 16, 2017 [2 favorites]

I developed an allergy to the adhesive for a generic patch I wear. The chain pharmacy I was using was not able to change to another generic, because the buyer used what was cheapest from a single enormous drug supplier (McKesson) and supplied all the stores in the state. I took my prescription to a local independent pharmacy, requested that they obtain the medication from another manufacturer, and they were able to do so. This doesn't address the copay issue, and I'm guessing that either your copay is a percentage or the medication's tier has changed, or your dad's pharmacy coverage itself has changed. (Not all generics are in the lowest tier, by the way). Your insurer should be able to tell you exactly why your co-pay increased. Sometimes a medication is covered in a lower tier if it is not the Long Acting or Extended Release formulation, and this might have changed in your coverage. Insurers change tiers and covered formulations all the time, and often don't notify you. It's a frustrating racket.

Have you tried to look at the pharmacy insurer's website? They usually have all the tiers and co-pays listed. Co-pays are sometimes a flat fee and sometimes a percentage, and the websites are usually kept pretty up-to-date.
posted by citygirl at 12:43 PM on November 16, 2017

I can't speak to the price but I can speak to getting meds from a specific manufacturer.

My grandmother was meticulous (and turned out to be a bit paranoid) about her medications. If it looked different she was suspicious of it, and was convinced it didn't work like the "original" did. Getting her meds from a big chain store (WalMart, Walgreens, CVS, etc) was a nightmare for us because their shipments came from whichever distributor the corporate office signed a contract with. We talked to those pharmacists (and I have a good friend who works for CVS) and they all confirmed that they had little control over what they were sent each month. Sometimes they could get meds from a specific manufacturer, but many times they could make the request but it wouldn't be honored. It was just something not controllable at the store level in many cases.

We finally went with a locally owned pharmacy who didn't contract with one specific supplier. They could call up any manufacturer and order their supplies, which is exactly what they did for my grandmother (BLESS THEM FOREVER for doing that!). She had one medicine (Synthroid maybe? I can't remember) that was the ONLY medicine they got from that particular supplier, but they did it for her each month because they were awesome people.

Definitely have a conversation with someone at CVS to see what their options are, but also look around and see what other pharmacies are available for you to use and consider talking to them. Build a relationship with the pharmacy and they should be willing to do what they can to help you out. CVS was more willing to work with us than WalMart, but even they had some challenges they couldn't iron out in getting certain meds.
posted by MultiFaceted at 1:30 PM on November 16, 2017 [2 favorites]

Outside of the insurance and cost difference, I recently ran into this with my ADHD medication. I brought it up with my psychiatrist, and he made sure to specify the other manufacturer in his prescription.
posted by SansPoint at 1:48 PM on November 16, 2017

If you don't understand why the price is different, don't jump to assumption that it is the manufacturer that is the problem. I would start by trying to figure out what happened:
1. Double check the bottle, make sure it really is the med that you need (although you probably already did that
2. Call the pharmacy, tell them you don't understand why the price is different. Ask them to make sure that they billed the insurance company for the correct quantity and medication
3. Go to your account on the insurance company website. Check the Explanation of Benefits (EOB) from the insurance company for the purchase - see what it says, also double check what they were billed for. While there, also check the plan year and the deductible. Is there any chance that your plan started a new year and you have to pay the deductible again?
4. Call the insurance company and ask them to explain.
posted by metahawk at 9:49 AM on November 17, 2017

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