When a patent expires for a brand drug, the FDA sometimes grants a period of exclusivity (typically lasting six months) to one company to make the generic form of the drug. The company may be the same maker as the brand drug or an entirely different company. During this time, there is a “single source” for the generic drug and no other company can produce the generic until the exclusivity period expires.
Higher cost of single-source generics
A single-source generic drug is more expensive than other generics because the drug is made by only one pharmaceutical company. Today, many HMSA drug plans recognize single-source generics, which means that these drugs are placed in the preferred brand level of copayment. However, some plans don’t recognize single-source generic drugs and cover such drugs at the plan’s generic level of copayment. Eventually, all HMSA Choice and Select drug plans (except for Medicare Part D plans) will include single-source generics. This helps to keep health care costs affordable.
Once the drug is no longer a single-source generic and the cost of the drug drops, it’ll be moved to the generic copayment level. To find out what your plan copayment is for single-source generic drugs, please refer to your drug plan certificate.
How to save on single-source generics
To save on your drug costs, check your drug plan certificate to see if you have mail-order benefits. Single-source generics are covered at the generic level under HMSA’s mail-order programs; when purchased at a retail pharmacy, however, single-source generics are covered at the preferred brand level.