The health plans are not obligated to provide specific drugs produced by specific manufacturers; when relevant, they are only required to provide drugs with an identical active ingredient as those that are included in the healthcare basket
Policyholders may switch to a health plan that provides a specific generic drug, or they may try and make their health plan provide a specific generic drug by contacting the Commissioner

In the event that a drug is included in the healthcare basket the health plans are not obligated to provide the policy holder with a specific drug produced by a specific manufacturer (brand-name drugs). They are only obligated to provide a drug with an identical active ingredient (generic drugs).

  • Generic drugs are different than brand-name drugs, which are originally developed by the manufacturer and are patent-protected.
  • After a brand-name drug's patent protection expires, other companies may manufacture copies of the drug.
  • These copies are called generic drugs and have the same active ingredient and are less expensive then the brand-name version.
  • Even if drugs are identical, patients sometimes complain about differences between one generic drug and another.
  • In such cases, if a patient took a specific generic drug and the health plan replaced it with a different generic drug, the policyholder may claim that the health plan is obligated to continue providing the original generic drug due to the Principle of Treatment Continuity.

Who is Eligible?

How to Claim It?

Please Note

  • There are differences between the health plans regarding which generic drugs are provided. Accordingly, policyholders interested in a specific generic drug may check which health plans provide it. Policyholders may switch health plans if the drug is available through another plan. For more information, see: Switching Health Plans.

Aid Organizations

  • For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.

Government Agencies

Laws and Regulations

Additional Publications