Generic Substitution Program

Generic substitution is the process by which a generic equivalent is dispensed rather than the corresponding brand name product. ConnectiCare benefit designs promote the use of generic drugs and, in many cases, we require additional member cost share will apply if the generic is not dispensed, even if the physician writes “no substitution.” Please promote the use of generics whenever possible and appropriate. Below is a description of how ConnectiCare chooses which drugs to recommend in the generic form.

The Maximum Allowable Cost (MAC) list sets a ceiling price for the reimbursement of certain generic prescription drugs. The drugs selected for inclusion on the MAC List have gone through the FDA’s review and approval process. This process generally assures the following conditions are met:

1. The generic drug must contain the same active ingredient(s), be the same strength and the same dosage form as the brand name counterpart.
2. The FDA has given the generic an “A” rating compared to the branded counterpart and has determined it to be therapeutically equivalent. The ratings of generic drugs are available to the Approved Drug Products with Therapeutic Equivalence Evaluations (Orange Book).
3. When the patent for a branded product expires and the generic is readily available from at least one manufacturer.

When the above criteria are met, a generic can be substituted with the expectation that the substituted product will produce the same clinical effect and safety profile as the prescribed product. In addition to the “A” rated products, there are some “unrated” products on the MAC list. Unrated products are generally pre-1938 drugs, which have not undergone the FDA review and approval process.