As 2014 comes to a close, we should be thinking about what to expect for 2015. The start of a new year is a time for new challenges, new goals, and inevitably, a new prescription formulary.
What does this mean for you?
Express Scripts and Caremark have decided to remove certain asthma maintenance inhalers from their national preferred formulary and provided a list of covered alternatives. For more information and the full list of excluded drugs, see our post on the 2015 formulary changes.
What if my prescription is on the exclusion list?
- First, confirm whether Express Scripts, Caremark, or another PBM manages your pharmacy benefits. Many drugs that aren’t covered by one company are covered by the other.
- Next, check with your plan to be sure that your prescription won’t be covered. Not all plans use the national formulary, and yours may vary.
- If your prescription won’t be covered, it doesn’t hurt to try appealing. Ask your doctor to write a note, and ask your plan for information on how to appeal for coverage. This is more likely to work in cases where you’ve tried the other options and they don’t work for you, or there’s a medical reason why you aren’t able to take the covered alternative.
- Finally, get in touch with your doctor and explain that your current prescription will no longer be covered by your insurance in 2015. Show thm the list of preferred alternatives. You and your doctor can decide which alternative to try, or whether to explore other options for coverage.
So what are the changes for diabetes coverage in 2015?
Thankfully, the only change for the 2015 formulary is the removal of Aerospan. Aerospan is not a commonly used steroid inhaler, and I don’t see this being a big problem.
Reminder: in 2014, Caremark also removed Alvesco from their national formulary. Alvesco is also not a commonly used steroid inhaler for many patients, and the removal was fairly unremarkable. The suggested alternatives, in particular Flovent and Asmanex, are the most popular steroid inhalers dispensed at most pharmacies and would be great alternatives for patients who may have previously been on Aerospan or Alvesco.
Express Scripts 2015: No changes from the 2014 formulary
My main concern with last year’s change is the removal of one of the most popular and widely used steroid inhalers, Flovent. Most patients with asthma, especially children, use Flovent as a maintenance inhaler in conjunction with an albuterol rescue inhaler (Proair, Proventil, Ventolin). The alternatives Asmanex, Pulmicort, and QVAR are typically prescribed less often, however, once you’re transitioned they should provide similar anti-inflammatory action.
Asmanex, Pulmicort Flexhaler, and QVAR are covered on both formularies, and all have prescription savings cards or assistance programs. You can find additional savings for Asmanex here, Pulmicort here, and QVAR here.