Download (Demand Generics - Generic Drug Request Form).pmd

Generic Drugs
Safe. Effective. Affordable.
Generic Drug Request Form
Talk to your doctor or pharmacist to see if generic drugs are right for you. Then sign and give this
request form to your doctor to place in your medical file. It can help you save money again and again.
YES, I want to help contain health care costs by requesting a generic prescription drug whenever
available and appropriate for my treatment.
Sign your name here
And add the date
The Facts About Generic Drugs
Generic drugs are approved by the FDA (the Food and Drug Administration) as safe and
effective choices you can make — and they save you money.
Generic drugs are safe, effective and affordable. They’re made with the same active ingredients and produce the
same effects in the body as their brand-name equivalents. By federal law, each generic drug is laboratory-tested to
make sure that the same amount of drug will be absorbed into the bloodstream.
The difference? Just the name and price—and generics cost less. For more information, visit the
BlueCross BlueShield of Tennessee Web site at www.bcbst.com.
801 Pine Street
Chattanooga, TN, 37402
www.bcbst.com
BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association ® Registered marks of the BlueCross BlueShield Association, an Association of Independent BlueCross BlueShield Plans