Generic Incentive Program

The voluntary RegenceRx Generic Incentive Program, allows members taking certain generic medications to receive up to a 30-day supply at no cost. Over 25 generic medications (view list) are part of this program.

Previously, members could only receive samples of branded medications supplied by pharmaceutical manufacturers to their physicians. Now they can try a generic with no initial financial obligation before filling the balance of their prescription.

Each 1 percent increase in generic utilization represents a savings of approximately $12 million dollars. Combined with the FDA establish safety and efficacy of generics, it’s a win-win combination. 

We hope our program both encourages physicians to save their patients money by writing more generic prescriptions and encourages our members to specifically ask for generics.

FAQs

1. Who is eligible for the RegenceRx Generic Incentive Program?
   
   • Members with prescription benefits who are currently taking one or more of the selected brand medications are eligible for the generic incentive program.
   • Members who are starting therapy on the generic alternative and have no prior claims history for the specified medication within the last six months are eligible.
      
2. Who is excluded from the RegenceRx Generic Incentive Program?
   Members without traditional prescription coverage, including all vendor auto-pay programs, Health Saving Accounts and discount plans.*
    
   * Discount plans refer to members who receive a discount on their medication price by presenting their insurance card, yet they have no pharmacy benefit, i.e., Medicare Supplement members. These members pay 100% of the discounted price.
    
3. Is a member eligible to receive the incentive more than once?
   A member may only receive the incentive for a particular drug once. For example, if a member takes Nexium® and switches to Prilosec OTC™, they can receive a one-month supply of Prilosec OTC  at no charge, one time only. However, the same member is eligible to receive the incentive on a different drug if, for example, they were switching from Altace® to lisinopril.
    
4. Can the member receive the incentive via mail order?
   No, the program is offered at the retail level only. Also, paper claims are not eligible for the program. The program is adjudicated electronically and therefore must be received by electronic transmission.
    
5. How many days supply is the member eligible for?
   A member is eligible for up to a 30-day supply. Members with greater than a 30-day benefit may only have a zero-dollar copay on the first 30 days worth of medication. The member may then refill their prescription for their usual days supply and receive it at their generic copay.
    
6. What medications are eligible for the incentive?
   Over 25 generic alternatives (specifically oral tablets/capsules) are eligible for the incentive program. View list of eligible medications. Over-the-counter (OTC) medications are excluded from the program, with the exception of Prilosec OTC.
    
7. And what about Prilosec OTC? It’s not available in a 30-day supply.
   A member may receive up to a 14, 28, or 42-quantity package of Prilosec OTC at no charge.
    
8. How would a prescription be processed to receive the generic alternative at no charge?
   Prescriptions are processed as any other prescription. If the member is eligible for the incentive, the claim will result in a zero-dollar copay.
    
9. Can a member submit a paper claim for the incentive?
   No, the claim must be submitted electronically. If the generic alternative prescription is processed initially as a paper claim, the member will no longer be eligible for the program.