(I read Pharmacy Chick's latest post and thought I'd like to put my own 2-cents in on this topic).
I believe that a prescriber should only be able to write for Brand Medically Neccessary if the patient has tried every single other option, and the doctor thoroughly documents how the generic was either ineffective or not tolerated. Basically, every single Brand Medically Neccessary script should require Prior Authorization, and insurance companies should strictly enforce this.
I'm sick of this brand name bullshit. Zocor is simvastatin; Norvasic is amlodipine; Toprol XL is metoprolol succinate. There's no fucking difference between the brand name and the generic except perhaps a little extra filler in one tablet. Hell, 1/2 the time, the generic is made by the same company that makes the brand name. There's almost no possible way a brand name could work any better than an AB rated generic. The only possible excuse I can think of is that someone could be allergic to certain dyes and therefore, requires the brand name that doesn't contain these dyes. Of course, the patient could probably switch to another generic manufacturer and accomplish the same thing.
I don't think doctors should be able to write Brand Medically Neccessary simply because the patient is some old lady who won't touch anything generic. I can't even count how many times I've seen absurdity like this: Lipitor, Brand Medically Neccessary. Uhhhh.... There is no generic for Lipitor yet. How do you know the brand name is medically neccessary if the patient has never even tried the generic? I actually think doctors should be reported for writing scripts like that. Basically, it's insurance fraud.
In my world a patient would not only have to fail a trial of a generic drug, but they'd have to exhaust almost every other clinically equivalent generic option in the same drug class. For example, if a patient fails pantoprazole, they'd have to also fail omeprazole before Protonix would be covered under the insurance.
If the patient truly needs the brand name, then he is entitled to it. However, all other options have to be exhausted and the therepeutic failure must be well documented. I guarantee that if a rule like this was enforced, you'd see a whole lot fewer Brand Medically Neccessary prescriptions, and the effect it would have is to lower the cost for patients, insurance companies, and increase the reimbursements to pharmacies. It's a win for every involved.