What is the HNE Performance Formulary?
The HNE Performance Formulary contains all generic medications and carefully selected brand name drugs divided into two tiers, each with a different copayment. The HNE Performance Formulary has medications available in each therapeutic class. If a medication is not listed in the HNE Performance Formulary, the member will be responsible for payment of the cost of the drug after the HNE drug discount rate is applied.  The discount rate varies by the particular drug, but is generally between 10% and 30% of the retail cost. The drugs on the formulary have been chosen based on clinically sound evidenced based medicine with a focus on generics and value. All therapeutic classes will have at least one medication in either the generic or brand tier of the HNE Performance Formulary.

Under the HNE Performance Formulary, a medication will fall into one of the following categories

Generic Drugs:
Approved by the U.S. Food and Drug Administration (FDA), Generic Drugs (Tier 1) contain the same active ingredients as brand name drugs, are just as safe and effective, and usually cost less. HNE encourages the dispensing of generic drugs whenever possible. Generic drugs have the lowest copayment.

Formulary Brand Name Drugs:
Brand/Formulary Drugs (Tier 2) are marketed under a trademarked brand name, usually by one manufacturer, and do not have less costly generic equivalents. Formulary Brand Name Drugs are selected based on a review of the relative safety, effectiveness and cost of the many FDA-approved drugs on the market. Your copayment for Formulary Brand Name drugs is higher than for Generic Drugs.

Non-Formulary Brand Name Drugs:
Any brand name drug that is not on the HNE Performance Formulary falls in this category.   This category includes, but is not limited to, any brand name drug that has a generic equivalent (the generic is therefore available at the lowest copayment). You and your doctor may decide that a Non-Formulary Brand Name Drug is the most appropriate medication for you. The member will be responsible for the full cost of the drug after the HNE discount rate is applied.

What About Mail Service Prescriptions? :
The mail order service for prescriptions on the HNE Performance Formulary works the same way as it does for the HNE Formulary.  You may obtain a 90-day supply of maintenance drugs through an HNE participating mail order supplier.  In general, a medication is classified as “maintenance” if it: 1) is used for chronic illnesses such as asthma, allergies, high blood pressure, etc.; and 2) has been obtained by prescription at least twice at a participating pharmacy. Each copayment applies to a 90-day supply or less.  The quantity of drugs in a 90-day supply is based on normal dosages.  See your membership materials for more information.  The following items may not be purchased through the mail service:

• Any drugs for which mail service is prohibited by law.
• Prescriptions for which a 90-day supply may not be appropriate as determined by HNE.
• Injectables.

How does this Formulary differ from HNE’s standard formulary? The HNE Performance Formulary differs in that there are specific medications in each tier:  Tier 1 includes generic drugs; tier 2 includes specifically selected brand name medications.  All therapeutic classes of drugs are included in tiers 1 and 2.  Any brand name drug not specifically listed in tier 1 or tier 2 may be obtained at a participating pharmacy at the HNE Discount Rate.
 
Key Differences:

What are Generic drugs?
A generic drug is a copy that is the same as a brand-name drug in dosage safety, strength, how it is taken, quality, performance and intended use.  A company is able to make a copy of a drug once the patent on that drug expires.  Most new prescription drugs have up to a 20 year patent which prevents the availability of generics

Are generic drugs as safe and as strong as brand-name drugs?
Yes.  FDA requires that all drugs be safe and effective.  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.  The FDA also requires generic drugs to have the same quality, strength, purity and stability as brand-name drugs.

Why are generic drugs less expensive?
Generic drugs are less expensive because generic manufacturers do not have the investment costs of the developer of a new drug.  New drugs are developed under patent protection.  The patent protects the investment – including research, development, marketing and promotion – by giving the company sole right to sell the drug while it is in effect.  As patents near expiration, manufacturers can apply to the FDA to sell generic versions.  Because those manufacturers do not have the same development costs, they can sell their products at substantial discounts.  Also, once generic drugs are approved, there is greater competition, which keeps the price down.  Today, more than half of all prescriptions are filled with generic drugs.

If brand-name drugs and generic drugs have the same active ingredients, why do they look different?
In the United State, trademark laws do not allow a generic drug to look exactly like the brand-name drug.  However a generic drug must duplicate the active ingredient.  Colors, flavors and certain other inactive ingredients may differ.

Does every brand-name drug have a generic counterpart? 
No.  Brand-name drugs are generally given patent protection for 20 years from the date of submission of the patent.  This provides protection for the innovator who experienced the initial costs of research, development and marketing expenses to develop the new drug.  However, when a patent expires, other drug companies can introduce competitive generic versions after they have been thoroughly tested by the manufacturer and approved by the FDA.

Is there a printable version of the new formulary that I can bring with me to the doctors?
There are printable versions organized alphabetically.  These lists are available for download here or you can request that a copy be mailed to you by calling Member Services at 413-787-4000

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