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Generic Drugs - Frequently Asked Questions

Generic Drug FAQ

What is a generic drug?

A generic drug is the same as a brand name drug in:

  • dosage, strength, safety, quality,
  • the way it works, and
  • the way it is taken.
What is the difference between a generic equivalent and a generic alternative?

A generic equivalent is a drug that contains the same active ingredient as the brand name drug. For example, lisinopril is the generic equivalent of brand name drugs, Zestril® and Prinivil®.

A generic alternative is a generic drug that works in the same way as a brand name drug and treats the same condition. The drug lisinopril, for example, is a generic alternative to the brand name drug, Altace®. Both drugs lower blood pressure, but they do not contain the same exact active ingredients. Generic alternatives are equal to the brand name drug in safety and how well they work.

Are generic drugs as safe as brand name drugs?

Yes. The United States Food and Drug Administration (FDA) requires that all drugs are safe and effective. Generic equivalent drugs use the same active ingredients as brand name drugs and work the same way.

Will the pharmacy give me a generic drug if one is available?

Yes. Unless told not to do so, network pharmacies may give you a generic drug instead of a brand name drug.

Are generic drugs as strong as brand name drugs?

Yes. FDA requires generic drugs to be equal to brand name drugs in quality and strength.

Do generic drugs take longer to work in the body?

No. Generic drugs work in the same way as brand name drugs.

Will generic drugs act the same way as brand name drugs with over-the-counter drugs?

Yes. Generic drugs will act the same way as brand name drugs. Be sure to tell your doctor about all of the drugs you take.

Are brand name drugs made in better factories than generic drugs?

No. The FDA says that all factories must meet the same high standards.

Does every brand name drug have a generic equivalent?

No. New brand name drugs have a patent when they are first made. The patent does not allow another drug company to make and sell the drug. Most drug patents last for several years. When the patent expires, other drug companies can start selling the generic version of the drug.

Why do generic drugs cost less?

Making a new drug costs a lot. Since generic drug companies do not create a drug from scratch, the costs are less. Generic drug companies must prove that their drug acts in the same way as the brand name drug. The FDA approves all generic drugs before they are released to the public.

Why would my doctor choose a generic over a brand drug?

Generic drugs are proven to be safe and work well. By choosing generic drugs, you can also save money in most cases.

How can I find out more about generic drugs?

Talk to your doctor or pharmacist to learn more about generic drugs.

Information last updated 04-03-2013

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General Purpose
Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements. Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net's National Medical Advisory Council (MAC). The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine.


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The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. Members should consult with their treating physician in connection with diagnosis and treatment decisions.


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The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply.


Policy Limitation: Member's Contract Controls Coverage Determinations.
Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member's contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, the Member's contract shall govern. The Policies do not replace or amend the Member contract.


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The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.


Reconstructive Surgery
California Health and Safety Code 1367.63 requires health care service plans to cover reconstructive surgery. "Reconstructive surgery" means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following:


1. To improve function; or
2. To create a normal appearance, to the extent possible.


Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance.


Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery.


Reconstructive Surgery after Mastectomy
California Health and Safety Code 1367.6 requires treatment for breast cancer to cover prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician and surgeon.


Policy Limitations: Medicare and Medicaid
Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law and regulation.

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