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Provider Manual

Generic Substitution

Last Updated on August 28, 2018

Security Health Plan has a mandatory generic substitution policy. If a member requests the brand name product for a medication where a generic is available, member must pay the applicable copayment or coinsurance plus an ancillary charge. The ancillary charge is the cost difference between the brand name product and the generic product. The ancillary charge will not count towards their out-of-pocket limit for prescriptions. Exceptions may be granted if the prescriber indicates brand is medically necessary, or if law/regulations do not allow for generic substitution.