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Question about Ocella

Discussion in 'Pharmacy' started by BlueberryMuffin, Jun 22, 2009.

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  1. BlueberryMuffin

    BlueberryMuffin

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    Hi there,
    I'm having a dispute with my insurance company over the co-pay amount for the drug Ocella. I thought Ocella was a generic substitute for Yasmin (this is what my pharmacist told me), but my insurance company is adamant Ocella is a "brand-name substitute" for Yasmin, and therefore subject to the more expensive brand-name co-pay.

    Can someone clarify this for me? I am a pathology intern and do not understand how all this pharmacy classification works. Thanks:)
  2. metrarx

    metrarx

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    ...
    Last edited: Jan 26, 2010
  3. Aznfarmerboi

    Aznfarmerboi Senior Member

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    Ocella is generic to Yasmin but in reality... they are more or less the same. Its made by the same manufacter, same location, same factory, and looks exactly the same.
  4. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    We had this issue when Ocella FIRST came out in that the systems didn't recognize it at all, so there was ZERO coverage.

    This sounds different though...what happens when a drug goes off patent is a "generic manufacturer" gets 6 months exclusivity in making the drug, and more often than not, the "generic manufacturer" is actually affiliated with the original brand. I can't remember, but I swear I read that Bayer (orig. manufacturer) makes Ocella and markets through Barr (generic manufacturer). Someone double check me on that.

    That's why when something goes off patent, the price doesn't drop right away...it's not until AFTER that 6 month generic exclusivity that others can jump in to drive the price down. It could be that, due to the price, your insurance company is classifying it as a brand and not a generic.

    I just typed this out of my ass so someone back me up or refute what I just said.
  5. Old Timer

    Old Timer SDN Advisor SDN Advisor

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    Some companies do this when the "Authorized Generic" is made by the name brand company. Many insurance companies do not recognize these as a generic version.
  6. BlueberryMuffin

    BlueberryMuffin

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    Thanks for your input. Is there any kind of documentation or evidence you can think of to support my claim that Ocella is generic? Something official looking that I can find off the internet and mail into my insurance company?

    My insurance company has justified charging me the wrong co-pay by saying "well...according to Medco, Ocella is Tier 2 and we classify this as brand name", but none of this Medco tier classification is stated in my policy.

    I went ahead and filed a complaint with my state dept of insurance and BBB.
  7. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    Ah, the byzantine nature of insurance coverage. Honestly, it's probably in the fine print, and usually state insurance dept's won't investigate unless it's something major (ie denied covering chemotherapy, major surgery, etc...). Just consider it "brand" for now and wait until other manufacturers jump in to drive costs down, just check in with your local pharmacy now and again and ask if different manufacturers have started shipping generics for Yasmin.

    But yeah, most insurance co's I've dealt with charged Ocella at the generic rate. Sounds like your insurance kind of...sucks :thumbdown:

    Hey Old Timer/aznpharm/anyone else.... what's the cash price for Ocella now in your system? Is it still ~$60?
  8. charfdorn

    charfdorn

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    My wife takes Ocella. The literature that comes with it says it is generic for Yasmin. It is distributed by Barr; I don't know whether it's actually made by Bayer or not. My insurance company has three tiers and Ocella is on the lowest tier (with other generics). Your insurance company sucks. Maybe you should call them back and talk to someone different.

    Incidentally, how much is the difference between tiers? With my insurance it's $10, and $10 a month would be worth it to me to avoid the hassle, at least for a while. I'd imagine one of these months you'll go in to get some Ocella and it'll suddenly be cheaper.
  9. BlueberryMuffin

    BlueberryMuffin

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    Good point about the literature. I looked through the packet that comes in the little OCP box and I couldn't find where it says it is generic. :(
    Maybe I need to request the more detailed pamphlet from the pharmacist.

    The co-pay difference is $5. However, I take this med continuously, skipping the placebo pills for medical reasons so I go through 16 packs in a year. So 16 x $5...$80.

    And yes, my insurance company does suck.
  10. DrugDealer

    DrugDealer Senior Member

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    $5 is actually a pretty small difference between a brand and generic copay. And maybe your insurance company meant it was a "branded generic"?
  11. pharmacology888

    pharmacology888

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    I have a similar question regarding brand and generics (sorry for this tangent to ocella). Both Fortamet and Glucophage XR are extended release metformin, how does the patent (20 year exclusivity for brand name drugs) work if there's 2 brand names for the same drug formation?
  12. PharmDstudent

    PharmDstudent

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    Hmmmm... good question. I don't know off-hand, but I'll look into it. Drug Info Handbook says that it's available in 500mg (+ other strengths) for all types, so there must be something different in order for them to be marketed seperately.
  13. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

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    The insurance company can charge whatever they want...especially if the drug in question has a brand-name of any sort attached to it. There is no official list of "which drug is brand, which is generic for insurance billing purposes" out there. There is just the Orange Book...and it compares bioequivalencies. If you want my advice...fighting it will get you nowhere and will just be a waste of your own time...
  14. pharmacology888

    pharmacology888

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    Thanks for looking into it! I know both Fortamet and Glucophage XR is both metformin HCl, but Glucophage XR just has the 1000 mg strength inaddition to the 500 mg (Glucophage XR only has the 500 mg strength). Inaddition, Glumetza, is also available as metformn HCl extended release 500 mg and 1000 mg.
  15. gabapentin

    gabapentin Drug dealing 4 life!

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    I work at pharmacies that mainly have students as patients, so it gets interesting. But when the girls got switched to Ocella...some went nuts (even to think it wouldn't hold back the kids from popping out). Here are some comments from sorority message boards. I find them entertaining.

    Has anyone changed from Yasmin to Ocella? I've felt fine all day and I took my first pill an hour or so ago and I instantly started feeling real nauseous. I googled it and now I'm seeing all kinds of side effects that people are having. Has anyone else's pharmacy switched them? If this pill affects me so much, I'm wondering if they pharmacy will give me a free pack of Yasmin since I didn't ask to be switchd.

    My doctor and I are convinced that my switching to a generic has something to do with my weight gain. It times too perfectly and there is no other reason for me to gain almost 40lbs in such a short time. My diet didn't drastically change and I was actually exercising more. Once I switched off, I lost 20lbs in about 1 1/2...with no diet change. Now only if I could lose the rest....but thats another thread.

    This was after someone posted that Ocella is identical to Yasmin bc its from the same company:
    I don't believe you.
    Old Navy is made by the same company that makes Banana Republic, but the quality is most assuredly not the same.
  16. gabapentin

    gabapentin Drug dealing 4 life!

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    To add to the metformin extended release question:

    From the ads we get in the pharmacy, apparently, Glumetza has an innovative tablet matrix to reduce the GI side effects.
  17. npage148

    npage148 Senior Member

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    This is why we totally need to educate the public about bioequivalence and what AB rated is!
    Last edited: Jun 26, 2009
  18. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    I think you missed the fact that he was quoting a message board full of college sorority girls.
  19. npage148

    npage148 Senior Member

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    Haha, I'm kinda slow. I'll fix it up
  20. FarscapeGirl

    FarscapeGirl

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    I think the last three paragraphs in gabapentin's post were what he read on a sorority posting about Ocella.

    Maybe, Gabapentin, you should put quotes around what you took off the posting... It is a bit confusing!
  21. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    haha it's ok, i reread it and agree the sorority thing is kinda hard to spot
  22. bananaface

    bananaface Pharmacy Supernerd Staff Member Administrator SDN Senior Moderator Lifetime Donor

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    Ditto on what WVU said. Insurance companies can charge less for brand and more for generic they want. Pacificare does it alot. The BBB, etc should not come into play at all. If want to convince the insurance company that Ocella is generic Yasmin, about all you can do is pull info from the orange book showing that Yasmin is the Reference Listed Drug (RLD) and that Ocella is AB rated to that product. www.fda.gov/cder and click "orange book". It's on the right under "Spotlight". Query by active ingredient, DROSPIRENONE.

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