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80+ Drugs to Be Dropped By Insurance in 2018

by Elizabeth Davis on August 22, 2017 at 4:30 pm

If you’ve got health insurance, now’s a good time to be paying attention. Each year, prescription coverage changes, and yours will likely be changing in 2018.

Express Scripts and Caremark, companies that handle pharmacy benefits for more than 200 million Americans, are removing more than 80 prescription medications from their formularies at the end of 2017. There is a silver lining for some of you though—almost 20 currently excluded drugs will be covered in 2018.

Find out below how your coverage may be changing next year.

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 do formulary changes mean for you?

Listed below are brand name drugs for which there may be a less expensive brand or generic alternative available. If your benefits are provided by Express Scripts or Caremark and you are filling one of these prescriptions, you’ll pay the full cash price at the pharmacy in 2018. (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?

⇒ Express Scripts: 64 new drugs have been added to the Express Scripts national formulary exclusion list.

The biggest change for many folks will be the exclusion of epinephrine pen Auvi-Q and epinephrine (generic Adrenaclick)—the main competitors to EpiPen. This isn’t great, but how it affects you will depend on which version you use, and how much you’re paying now. The Adrenaclick generic has less-expensive cash prices, starting at $110, but EpiPen (and its generic alternative) are still more popular overall.

If you use a long-acting powerful pain medication, you may want to check your coverage—Express Scripts will also be excluding Opana ER and generic oxycodone ER, along with Lazanda (fentanyl). Abstral and Fentora (also fentanyl pain medications) are already excluded. Your covered options will be mostly generics like hydromorphone ER, morphine sulfate ER, oxymorphone ER, and fentanyl citrate lozenges.

To be fair, 46 of 64 newly excluded drugs are simply brand-name drugs that now have a generic alternative—and several of the others are brand-only drugs with similar generics available in the same class.

⇒ Caremark: 19 new drugs have been added to the Caremark national formulary exclusion list. Similar to Express Scripts, 5 of these are brands with generic alternatives available, and several others have similar options in the same class.

Diabetes medications appear to have the most new restrictions: injectable Tanzeum, and SGLT2 inhibitors Jardiance, Synjardy, and Synjardy XR will be excluded in 2018.

On the other hand, Caremark is adding 19 drugs back to their covered formulary, some as preferred medications and other non-preferred (meaning you may need a prior authorization or step therapy to get coverage). This is great news, as there are some commonly used medications on this list that don’t have generics or close alternatives. These include asthma and COPD inhalers Symbicort, Dulera, and Incruse Ellipta; Levitra for erectile dysfunction; and Invokana and Invokamet for diabetes.

2018 Excluded Drugs

You can see all of 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 plan administrator.

Aciphex (Express Scripts)
Aciphex (sprinkle) (Express Scripts)
Adderall (Express Scripts)
Androgel (1%) (Express Scripts)
Anusol HC (Express Scripts)
Atacand (Express Scripts)
Atacand HCT (Express Scripts)
Auvi-Q (Express Scripts)
Azor (Express Scripts)
Benicar (both)
Benicar HCT (both)
Bupap (Express Scripts)
Cymbalta (Express Scripts)
Cytomel (Express Scripts)
Doryx (Caremark)
Effexor XR (both)
Elelyso (Caremark)
epinephrine (generic Adrenaclick) (Express Scripts)
Femring (Express Scripts)
Follistim (Caremark)
Forteo (Express Scripts)
Fosrenol (Express Scripts)
Horizant (Caremark)
Hyalgan (Caremark)
Imitrex (Express Scripts)
Inderal LA (Express Scripts)
Intuniv (Express Scripts)
Jardiance (Caremark)
Lazanda (Express Scripts)
Lexapro (Express Scripts)
Librax (Express Scripts)
Lidoderm (Express Scripts)
Lovenox (Express Scripts)
Lunesta (Express Scripts)
Minastrin 24 Fe (Express Scripts)
Monodox (Caremark)
Nasonex (Express Scripts)
Neupogen (Express Scripts)
Nevanac (Express Scripts)
Opana ER (Express Scripts)
oxycodone ER (Express Scripts)
Plaquenil (Express Scripts)
Plavix (Express Scripts)
Prevacid (Express Scripts)
Prilosec (suspension) (Express Scripts)
Pristiq (Express Scripts)
Protonix (Express Scripts)
Provigil (Express Scripts)
Prozac (Express Scripts)
Pulmicort Respules (Express Scripts)
Renagel (Express Scripts)
Sandostatin LAR Depot (Express Scripts)
Seroquel (Express Scripts)
Seroquel XR (both)
Signifor LAR (Express Scripts)
Singulair (Express Scripts)
Strattera (Express Scripts)
Sumavel Dosepro (Caremark)
Synjardy (Caremark)
Synjardy XR (Caremark)
Synvisc (Caremark)
Synvisc One (Caremark)
Tanzeum (Caremark)
Tikosyn (Express Scripts)
Timoptic Ocudose (Express Scripts)
Tobi (solution) (Express Scripts)
Tribenzor (Express Scripts)
Trulance (Express Scripts)
Valium (Express Scripts)
Valtrex (Express Scripts)
Vytorin (Express Scripts)
Wellbutrin SR (Express Scripts)
Xanax (Express Scripts)
Xanax XR (Express Scripts)
Xenazine (Express Scripts)
Zegerid (Express Scripts)
Zetia (both)
Zoloft (Express Scripts)
Zyflo CR (Express Script

An important note about Medicare and individual plans:

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.

Some individual private insurance plans managed by Express Scripts or Caremark may also have different coverage. This means different drugs may be covered or excluded on your plan if you have coverage through work, for example. Please get in touch with your insurance provider if you have any questions about your coverage.


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