Health Crush Contributor
Insurance companies modify their drug formulary every year, around this time. Express Scripts, who is responsible for 83 million insurance plan members’ drug coverage, got the ball rolling by announcing their drug formulary exclusions for 2018.
Why do I need to know if my formulary has changed?
It’s important to know if your formulary is expected to change in the coming year, so you can start planning for what you will do if your drug’s coverage is dropped.
What can I do if my drug is dropped from my insurance’s drug formulary?
If your drug’s coverage is dropped from your insurance’s drug formulary, there are a couple things you can do:
1: Find out if there is a generic version of your medication available. Usually drug companies modify their formulary, because a less expensive version of the medication has been made available.
2: Talk to your physician about treatment options. Are there other medications your doctor can write a prescription for?
What is a drug formulary?
Drug formularies are lists of medications covered by insurance plans. Pharmacy Benefit Managers (PBMs) work closely with insurance companies to determine what medications their plans will cover.
Express Scripts has introduced 64 new drug exclusions to their preferred formulary. The company says their formulary is designed to bring the greatest value to their clients and members, while increasing the use of the lowest net-cost products. Express Scripts claims the updates to their formulary will deliver an additional $2.5 billion in client savings.
Always shop around for your medications
All hope isn’t lost if you find your medication on the updated formulary exclusions list. Since drug prices vary by pharmacy location and also by which insurance is used, you can often find deals on your medication costs. Using tools, like LowestMed, can help you find out which pharmacy has the lowest price for your medication. You can also use LowestMed’s search tool to find out if there is a generic equivalent for your medication.
Express Scripts’ Formulary Exclusions for 2018
- Aciphex sprinkle
- Androgel 1%
- Effexor xr
- Epinephrine auto-injector (by a-s medication, impax & lineage)
- Inderal la
- Minastrin 24 fe
- Opana er
- Oxycodone er
- Prevacid solutab
- Prilosec suspension
- Protonix suspension
- Pulmicort respules
- Sandostatin lar depot
- Signifor lar
- Timoptic ocudose
- Tobi solution
- Wellbutrin sr
- Zyflo cr
CVS says they remove drugs only when clinically-appropriate, lower-cost (often generic) alternatives are available. They say their targeted approach ensures minimum member disruption. CVS says they estimate 99.76 percent of members should not be affected by the formulary changes.
CVS Caremark Formulary Exclusions for 2018
- Doryx/Doryx MPC
- Sumavel Dosepro
- Benicar/Benicar HCT
- Effexor XR
- Seroquel XR
- Synjardy/Synjardy XR
- Synvisc/Synvisc One
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