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Will Your Prescription Drugs Be Covered Next Year? Better Check!

Open enrollment is upon us. If your employer offers more than one plan and you are like a majority of others, you’ll just reenroll in the same plan. It may not be perfect, but it’s working pretty well. Not so fast. On the surface, it may look identical to what you have this year, but maybe not. And it’s worth the time to look closely at it.

CVS Caremark and Express Scripts, the biggest prescription insurers, released their 2017 lists of approved drugs last month and each has a long list of excluded medications. Some of the drugs newly excluded are prescribed to treat diabetes and hepatitis. The CVS list also excludes Proventil and Ventolin, commonly prescribed brands of asthma inhalers, while Express Scripts had dropped Orencia, a drug used to treat rheumatoid arthritis.

There are any numbers of reasons that prescription insurers are dropping drugs from their tier programs. In many cases, the cost of the drugs to the insurer is too high, and by eliminating it from the formulary, they hope to negotiate discounts from the manufacturers. In some cases, such as CVS dropping two biologic drugs—Lantus and Neupogen– they will offer an alternative known as a biosimilar which is not the same as the brand name drug. Finally, if there is no generic alternative, the individual will have to go back to the doctor for a new prescription.

Although you may think that it is unlikely that anything on your list of medications is excluded, don’t assume. Take the time to research all prescriptions that anyone in your family takes on a regular basis. You’ll want to choose the plan that best addresses your family’s current prescription needs.

For additional information, contact EAB HealthWorks.