Request for Waiver of Brand Penalty
Depending on your benefits, you may be charged more if you receive a brand drug when a generic is available. Normally, this would require you to pay the difference in cost if you choose to use the brand drug. However, if there is a medical reason you must take the brand drug, we may not require you to pay the difference. Follow these steps to request a waiver:
- Your provider should submit FDA Form 3500 to the Food and Drug Administration (FDA) to let them know why you cannot take the generic drug. You can find more information, as well as the form to submit, at https://www.fda.gov/safety/medwatch External Site.
- Your provider should review the attached criteria, and if these guidelines are met, they can submit the Request for Waiver of Brand Penalty form/MedWatch Reporting Form PDF File.