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Frequently Asked Questions Insurance

Prescription Drugs

  • Each state has a law that allows pharmacists to substitute less expensive generic drugs for many brand names. However, if your doctor specifies that a brand name must be dispensed, then the pharmacist may not substitute the generic. Sometimes an acceptable generic is available that your doctor may not be aware of. In this case, your pharmacist may be able to consult with your doctor to suggest an effective medication that costs less.
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  • Every day, millions of Americans rely on medications to feel better and get well, but it is not always easy to take them correctly. Not taking medications properly can prevent you from getting well as fast as you can. Also, taking medicine with certain foods, alcohol, dietary/herbal supplements, or other medicines might cause a dangerous reaction, or it might stop your medicine from working as well as it should. Here are some questions that can help you get the information you need to use your medicines properly. If the answers seem complicated or confusing, ask again!
    1. What is the name of the medicine and what is it supposed to do? Is this the brand name or the generic name?
    2. How and when do I take it -- and for how long?
    3. What foods, drinks, other medicines, dietary supplements, or activities should I avoid while taking this medicine?
    4. When should I expect the medicine to begin to work, and how will I know if it is working? Are there any tests required with this medicine (for example, to check liver or kidney function)?
    5. Are there any side effects, what are they, and what do I do if they occur?
    6. Will this medicine work safely with the other prescription and nonprescription medicines I am taking?
    7. Can I get a refill? When?
    8. How should I store this medicine?
    9. Is there any written information available about the medicine? Is it available in large print or a language other than English?
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  • Yes. The FDA requires that all drugs be safe and effective and that their benefits outweigh their risks. Since generics use the same active ingredients and are shown to work the same way in the body, they have the same risks and benefits as their brand name counterparts.
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  • There is no evidence of this. The FDA monitors reports of adverse drug reactions and has found no difference in the rates between generic and brand name drugs.
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  • Yes. OPM does not prohibit FEHB members from participating in pharmacy-sponsored incentive or pharmaceutical company co-pay reimbursement programs, and we are unaware of any Federal laws restricting participation.  Enrollees in other Federal Programs such as Medicare and Medicaid are statutorily prohibited from participating in pharmacy incentive programs under section 1320a-7b of title 42, United States Code (the Anti-Kickback Act).  However, the FEHB Program is exempt from the application of this provision. OPM does not have authority over promotional incentive programs retail pharmacies choose to offer its customers, and OPM cannot direct retail pharmacies to provide the incentives to FEHB Program members. We are working with FEHB Program plans to remove any restrictions.
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