In 2020, members who require a brand prescription when a generic is available will pay the generic copay plus the difference in cost between the generic and brand drug.
For example: If the brand drug cost is $125, the generic drug cost is $25 and the generic copay is $5 then the final member cost is $105 ($5 copay + 100 difference in cost between the brand drug and generic drug)
This new pricing structure is already present in the 2020 Summaries of Benefits and Coverage (SBC’s) for their Small Group products.