November 14, 2016

Medicaid Reimbursements for Brand Name versus Generic

According to the Department of Social Services’ (DSS) website, HUSKY providers must generally prescribe generic drugs when they are available. By law, for medical assistance recipients, including HUSKY members, pharmacists must dispense a generically equivalent drug product for brand name drugs unless the prescribing provider has specified that the brand name drug product and dosage form is medically necessary compared to the generic substitution (CGS § 17b-274(b)). The law also requires DSS to require pharmacists to obtain approval from an independent pharmacy consultant acting on behalf of DSS when dispensing a brand name drug to a medical assistance recipient when a chemically equivalent generic substitute is available (CGS § 17b-274(c)).