The nation’s largest Pharmacy Benefit Manager (PBM) Express Scripts has announced that it will exclude 48 new drugs from insurance coverage in 2019. If you have got health insurance, it’s time to pay attention and prepare yourself for the upcoming changes.
Every year, PBMs like Express Scripts and Caremark make changes in the formulary after evaluating the prices and the clinical values of drugs. Their main objective is to increase patients access to appropriate medications by reducing prescription drug costs.
In 2019, the Express Scripts will drop 48 drugs from their National Preferred Formulary, which is providing access to 3886 medications to more than 25 million Americans. According to the press release by the company, these exclusions contain:
- 22 drugs that have low-cost generic alternatives. For example, Atripla will be dropped in favor of lamivudine, efavirenz, and tenofovir disoproxil fumarate (Symfi and Symfi Lo) as the list price of Atripla is 40% higher than its alternatives.
- 12 branded drugs that contain the same active ingredients but with a lower net cost.
- 11 specialty drugs that have a lower cost brand or biosimilar alternatives.
- 10 drugs with direct generic equivalents.
- 9 short-term therapies including topical creams and ophthalmic treatments.
Exclusions Made in Specialty Drug Categories:
We rarely see any changes in the specialty drug categories, but in 2019, you will find exclusions in three specialty categories: Multiple sclerosis (MS), HIV antiretrovirals and Factor VIII recombinant products.
Express Scripts Formulary 2019: Changes in the Hepatitis C Category:
Mavyret, a drug used for treating patients with HCV genotype 2 and 3 will not be covered in Express Scripts formulary 2019. A lower list price product Zepatier is added instead which was excluded in 2018 formulary. Other drugs used in treating Hepatitis C such as Harvoni, Epclusa or Vosevi will also be covered.
Express Scripts National Preferred Formulary Exclusion List 2019
The medications shown below will not be covered on the National Preferred Formulary beginning on Jan 1, 2019. If you are taking any of the prescription medications mentioned below, you will have to pay the full retail price. For alternatives to these medications that will be covered by your insurance see the list of exclusion changes here.
Note: This is not an all-inclusive list of exclusions for the National Preferred Formulary. The full list of excluded products will be available on or before September 5, 2018.
- Alcortin A
- Chorionic Gonadotropin
- Climara Pro
- Contrave EREmadine
- Fenoprofen (capsule)
- FML Forte
- FML S.O.P.
- Lupron Depot-Ped
- Namenda XR
- Neupro patchNorco
- Nutropin AQ Nuspin
- Oxycodone ER
- Pred Mild
- Topicort spray
- Verdeso foam
- Xerese cream
- Xyntha Solofuse
What to Do If Your Prescription Drug Is on the Exclusion List?
Most of the drugs found in the Express Scripts formulary exclusion list 2019 are brand-name drugs for which a less expensive or generic alternative is present. If your benefits are managed by Express Scripts, and your prescription includes any of the medications mentioned above, then you will be paying a full retail price for that drug next year.
You can always discuss with your doctor about an alternative medication that is covered by your insurance. If in case, you may still want to continue on your previous uncovered medication, then we would suggest to shop around and find the pharmacy that offers the lowest price for your prescription drug. You can use our drug pricing tool to compare prices at various pharmacies within your local area.
Another option is to use Discount Drug Network Prescription Discount Card which is available online at no cost.
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.
Qualifying patients can also look for patient assistance programs to cover the prescription medication costs.