Can your health insurer force you to use a generic brand of a medicine without your consent?

UPDATED: Oct 1, 2022

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Can your health insurer force you to use a generic brand of a medicine without your consent?

My husband has been taking Suboxone to aid in his sobriety for over 5 years. Last year his insurance company decided they were going to only fill the generic brand subutex and it really messed with my husband. He started becoming uncomfortable and feeling like he needed to take

more and more just to survive his day. He has now been off the generic brand and back on the name brand after his pharmacist fighting for him for 5-6 months and is still experiencing adverse affects. Do we have a case? I really do not want my husband relapsing or this happening to another person.

Asked on November 30, 2017 under Insurance Law, New Hampshire


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 5 years ago | Contributor

The health insurer can put limitations on what it will pay for in order to save money or reduce costs: e.g. that generics will be used instead of name brands. That is legal. Remember: generics are approved for the use by the FDA and should have minimal (if any) differences with name brands. They can be prescribed for the same exact things. Since the FDA regards them as equivalent, the insurer can say it will only pay for the less expensive one: that is not interfering with the medical care, because the generic may be used for the same treatment and conditions. Further, the insurer could not force your husband to use the generic against his will: he had the right to get the name brand and pay out of pocket for it. All they did was say that IF you want the insurer to pay, it must be the generic version; that is legal.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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