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50+ Brand-Name Drugs Dropped By Insurance in 2014

by Elizabeth Davis on October 29, 2013 at 1:03 pm

For  many Americans with health insurance, more than 50 popular brand-name drugs may no longer be covered starting in January 2014. Express Scripts and Caremark, companies that handles pharmacy benefits for more than 200 million Americans, are removing almost 50 brands from their formularies at the end of 2013. More information is below.

What are Express Scripts and Caremark?

Express Scripts and Caremark are companies that administer prescription drug benefits for many health insurance companies and Tricare. While you may have health insurance from Anthem, Aetna or another insurer, your pharmacy benefits are usually handled by these companies or their competitors. They also set the formulary for everyone under their prescription drug benefit.

What does this change mean for you?

The drugs listed below are brand names for which there may be a less expensive brand or generic alternative available. If your benefits are provided by Express Scripts or Caremark, you will pay the full cash price at the pharmacy for these brands in 2014. (You can see estimated cash prices on GoodRx by clicking on a pharmacy name after you look up a drug.)

If your coverage is changing, talk to your doctor to see if a covered alternative might work for you. If you can’t switch, you may be able to use GoodRx or find patient assistance programs to help cover the cost.

Which drugs are affected?

Under Express Scripts, many asthma, COPD, and diabetes drugs will no longer be covered, as well as a number of heart meds, cancer treatments, hormones, and nasal sprays. Some of the most notable drugs that will no longer be covered: Advair HFA and Advair Diskus, Flovent HFA and Flovent Diskus, and Proventil HFA inhalers, diabetes meds NovolinNovoLogVictoza, and all blood glucose test strips and meters except OneTouch.

These changes do not apply to Medicare plans; if your Medicare benefit is managed by Express Scripts, you should check your coverage with your pharmacist or online through the Medicare.gov portal.

Caremark also made significant changes in 2013, and is adding around thirty more exclusions in 2014. There is some overlap with Express Scripts on the drugs excluded, particularly when it comes to nasal sprays and hormones, and on the general categories covered, but most drugs appear only on one list or the other. For example, Caremark still covers insulins Novolin and NovoLog, while adding Humalog and Humulin to their exclusion list instead.

See the excluded medications below. For a full list of excluded drugs and covered alternatives, see the Express Scripts list here and the Caremark list here. If you’re not sure which company provides your pharmacy benefit, contact your insurance company.

2014 Excluded Drugs (*drugs excluded by Caremark in 2013)

Abbott Meters & Strips* (both)
Actos (Caremark)
Advair Diskus (Express Scripts)
Advair HFA (Express Scripts)
Advicor* (Caremark)
Altoprev* (Caremark)
Alvesco (Caremark)
Alvesco (Caremark)
Androgel* (Caremark)
Apidra (Express Scripts)
Arthrotec* (Caremark)
Asacol HD (Caremark)
Atacand HCT* (Caremark)
Atacand* (Caremark)
Auvi-Q (Express Scripts)
Avinza (Express Scripts)
Bayer Meters & Strips (both)
Beconase AQ* (both)
Betaseron (Express Scripts)
Bravelle (Express Scripts)
Breo Ellipta (both)
Cimzia (Express Scripts)
Delzicol (Caremark)
Detrol LA* (Caremark)
Diovan HCT (Caremark)
Dymista (Caremark)
Edarbi* (both)
Edarbyclor* (both)
Exalgo (Express Scripts)
Flector* (Caremark)
Flovent Diskus (Express Scripts)
Flovent HFA (Express Scripts)
Follistim AQ (Express Scripts)
Fortamet* (Caremark)
Fortesta (Express Scripts)
Genotropin* (Caremark)
Glumetza* (Caremark)
Hecoria* (Caremark)
Humalog* (Caremark)
Humulin* (Caremark)
Intermezzo* (Caremark)
Jalyn* (Caremark)
Jentadueto (Express Scripts)
Kadian (Express Scripts)
Kazano (both)
Kombiglyze XR* (Caremark)
Lastacaft (Caremark)
Lescol XL (Caremark)
Levitra* (both)
Lipitor (Caremark)
Liptruzet (Caremark)
Livalo* (Caremark)
Lumigan* (Caremark)
Maxair Autohaler* (both)
Micardis (Express Scripts)
Micardis HCT (Express Scripts)
Nesina (both)
Nipro Meters & Strips (Express Scripts)
Novolin (Express Scripts)
NovoLog (Express Scripts)
Nutropin AQ* (both)
Nutropin* (both)
Oleptro* (Caremark)
Omnaris* (both)
Omnitrope* (both)
Onglyza* (Caremark)
Oseni (Caremark)
Olux-E* (Caremark)
Oxytrol* (Caremark)
PegIntron (Express Scripts)
Plavix (Caremark)
Prevacid (Caremark)
Protonix (Caremark)
Proventil HFA (Express Scripts)
QNASL* (Caremark)
Rayos (Caremark)
Rhinocort Aqua* (both)
Riomet* (Caremark)
Roche Meters & Strips (Express Scripts)
Rozerem* (Caremark)
Saizen* (both)
Sanctura XR* (Caremark)
Simponi (Express Scripts)
Staxyn (Express Scripts)
Stelara (Express Scripts)
Suboxone film (Caremark)
Testim* (both)
Tev-Tropin* (both)
Teveten HCT* (both)
Teveten* (both)
Toviaz* (Caremark)
Tradjenta (Express Scripts)
Tricor (Caremark)
Tudorza Pressair (Caremark)
Valtrex (Caremark)
Ventolin HFA (Caremark)
Veramyst* (both)
Victoza (Express Scripts)
Xeljanz (Express Scripts)
Xopenex HFA* (both)
Zetonna (both)
Zioptan (Express Scripts)

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