It has been many years since pharmacies have been allowed to substitute brand name medications with generic medications. In fact, doctors have to write "dispense as written" if they want the patient to only get the brand name medication they prescribe.

Additionally, managed care organizations (MCOs, commonly known as insurance companies) do not pay for brand name medications just because a doctor prescribes them. If the MCO is aware of a generic option, then they will only pay for the generic or they will ask the doctor for a "prior authorization" to justify the use of a brand name medicine (such as the generic version not working).

The pediatricians I have visited in recent years even have the MCOs' formulary available for the patient in their systems, so they can see which medicines need a prior authorization and which do not so there is no time wasted on figuring out what the MCO will pay for without prior authorizations.