07/15/2011
Authorized copy of Concerta® not classified as generic
On April 29, 2011, an authorized copy of Concerta®—a medication for attention deficit hyperactivity disorder (ADHD)—became available. We initially processed claims for this authorized copy at a generic copay. However, because the authorized copy is not a true generic and doesn't offer cost savings over the brand-name product, RegenceRx® recognizes this authorized copy as a brand-name medication, not a generic.
Effective Aug. 1, 2011, RegenceRx will adjudicate claims for the authorized copy of Concerta at a non-preferred brand copayment for members with an open formulary plan. If a member recently filled a prescription for the authorized copy of Concerta at a generic copayment, the copayment for additional refills will be at the non-preferred brand copayment.
The authorized copy of Concerta will not be covered for members with a closed formulary plan and is not covered for Medicare Part D members unless they get approval through the non-formulary exception process.
We've sent letters to impacted members with open formulary and closed formulary plans whose copay or coverage status for this medication will change due to its designation as a brand-name. Some children on Healthy Options were impacted, and their guardians will receive a letter once it's approved by the Office of Insurance Commissioner. Medicare Part D members don't have high utilization of these types of medications, so there was no impact to them.
Formulary/preferred options are available to members and include but are not limited to Methylin, Methylin ER, Methylphenidate HCl, and Methylphenidate SR (Ritalin SR®).
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