How can a prescriber prevent generic substitution for Medicaid patients in Virginia?

A prescriber can prevent generic substitution for Medicaid patients in Virginia by writing "Brand Medically Necessary" on the prescription. This phrase is recognized as a directive that indicates the prescriber is specifying that the brand-name medication should be dispensed, rather than allowing pharmacists to substitute a generic equivalent. This requirement is emphasized in state regulations to ensure that patients receive the specific medication their prescriber has determined is necessary for their treatment.

While verbal indications of "No Substitution" are common in other contexts and may hold some weight, they lack the formal recognition and enforceability of a written directive. Prior authorization is a process that may limit certain medications but does not specifically pertain to preventing generic substitution. Simply using a known brand name does not explicitly prevent substitution; a pharmacist may still substitute as allowed unless otherwise directed by the prescriber. Thus, writing "Brand Medically Necessary" clearly communicates the prescriber’s intent and is the most effective method to prevent generic substitution under Medicaid in Virginia.