When it's filled in the military pharmacies, we always go with the cheapest one we can get. If we do have a drug in the contract, whether it's a brand name or generic—because sometimes we get brand name drugs cheaper than generic drugs—our pharmacies are made aware. Centrally, we just inform them of the brand they have to buy. If we don't have a contract, the local military pharmacist will go through whatever is available from the supplier and go with the cheapest one for the formulary.
For civilian pharmacies, because we can't really control what they have in stock, we basically have to open it up to whatever they have. If they give a brand name versus a generic, they will still be paid.
What we've seen, because we're so small a player across the country, is that as soon as we implement new rules that make it more restrictive, the patient has to pay out of pocket because the pharmacy doesn't want to do the necessary process to get paid. Then the patient claims it, for which they will be reimbursed, but it just adds a layer for the patient because they don't get it right away.