Insurance Companies Are Dropping Coverage from These 80+ Drugs
If you have got health insurance, it’s important to pay attention to changes in prescription drug coverage. Each year, health insurance companies and drug manufacturers make changes in the “formulary” ( prescription coverage) that can bring surprises for many consumers heading to the pharmacy.
Here we will discuss Express Scripts formulary and Caremark formulary.
In 2018, Express Scripts and Caremark are removing more than 80 prescription medications from their formulary lists. However, 20 drugs that have been excluded previously will be added this year.
Before we discuss the changes in Express Scripts and Caremark formulary, let us give you a brief introduction to these companies.
What are Express Scripts and Caremark?
Express Scripts and Caremark are companies administering the prescription drug benefits for many different health insurance companies.
Whether you have insurance from Aetna, UnitedHealthcare or any other insurer, your pharmacy benefits are most likely handled by one of these two companies. They have set their drug formulary list for everyone under their prescription drug coverage. If you like to know which company provides your pharmacy benefit, contact your plan administrator.
What Does Drug Formulary Mean?
Drug formularies are defined as the lists of medications your health insurance covers. Pharmacy Benefit Managers (PBMs) work closely with insurance companies to determine what medications should be included in their plans.
Drug formularies are divided into two to five groups based on price. Each group is typically associated with a copay, which is a flat rate you pay for the drug at the pharmacy.
Drugs Affected Due to Changes in Express Scripts Formulary and Caremark Formulary in 2018
If your benefits are provided by Express Scripts or Caremark, and your prescribed medication is no longer covered, you will have to pay full price at the pharmacy starting in 2018.
(You can find a local pharmacy with the lowest price for your prescription drug by using our drug pricing tool)
If your prescription drug is no longer included in Express Scripts formulary or Caremark formulary, do not panic. We have some tips that can help you take control of your costs.
Drugs Affected in Express Scripts Formulary:
64 new drugs have been excluded from the Express Scripts formulary list in 2018.
One of the most impactful change is the exclusion of epinephrine pen Auvi-Q, and epinephrine—these drugs are the main competitors to Epipen. It is definitely not a good thing to know for many patients that need these medications to survive. Adrenaclick, the generic alternative to epinephrine is comparatively cheaper, but still, is priced over $100.
If you are on long-acting pain medications, then this is the time to check your prescription insurance coverage. Opana Er, generic brand oxycodone ER, Abstral, Lazanda (fentanyl) and Fentora have been excluded from Express Scripts formulary.
To be honest, most drugs that have been excluded are simply brand-name drugs. Their generic equivalents are easily available and are much cheaper.
To view the complete list of excluded medications in Express Scripts formulary, click here.
Drugs Affected in Caremark Formulary:
19 drugs have been excluded from Caremark formulary list in 2018. Good news is that 5 of these brands have generic equivalents and several others have similar options available.
Diabetic medications, however, have been the main target. Injectable Tanzeum and SGLT2 inhibitors such as Synjardy, Jardiance, and Synjardy XR are not covered in 2018.
Caremark has decided to include 19 drugs back to the covered drug formulary which includes Symbicort, Dulera, and Incruse Ellipta (asthma and COPD inhalers), Invokana and Invokamet for diabetes and Levitra for treating erectile dysfunction.
To view the complete list of excluded medications in CVS Caremark formulary, click here.
What to Do If Your Drug Is No Longer under Prescription Insurance Coverage?
If your insurance coverage no longer covers your drug, do not worry. Here are some tips that can help you save money on your prescribed drugs:
Talk to your doctor and pharmacist about any generic or cheaper alternatives. Most of the drugs have similar equivalents that are just as effective as prescribed medication but at a lower cost.
Always shop around for your medication. Not all pharmacies charge the same price for individual drugs. You can use our drug pricing tool to find out which pharmacy in your local area has the lowest price on your medication.
Sign up for a free prescription discount card – It is by far the easiest and quickest way to save some cash on your pharmacy bill.
Discount Drug Network covers millions of people and leverages the power of group purchasing to negotiate these discounts on behalf of our cardholders. The pharmacies agree to let our members get discount pricing (just like they do already for insurance customers) because they want our business!
They not only give our members fantastic discounts, but they also pay us a small transaction fee each time we process a prescription through our network. This allows us to continue to operate, grow, and save our members money! For the first time, the individual consumer gets access to pricing typically reserved for the largest insurance companies.
If your prescription is included in Express Scripts formulary or Caremark Formulary exclusion lists, try not to worry. Use our tips and free discount card to manage your family healthcare budget. Visit our homepage for more information.