More Formulary Changes for 2015

Elizabeth Davis
Posted on

As you may know from experience, or from one of our previous articles on changes in coverage in 2014 or 2015, it’s typical for prescription benefit managers (PBMs) to exclude medications from their national preferred formularies each year. These may be brands that have generics available, or generally expensive medications where your plan feels a cheaper alternative may work just as well.

It’s less likely that existing drugs will be added back to the preferred formulary (or at least removed from the exclusion list), but that happened this year in several cases for Express Scripts and Caremark—two major PBMs. This could be good news, particularly if you use some popular medications like Advair and Auvi-Q.

There are a few other details to note about these changes—for one thing, just because a medication has been removed from the excluded list, that doesn’t mean that it is now considered a preferred alternative. You may still find that it costs more or falls under a higher tier, even if you do have coverage. Here’s a quick summary of the changes, but you’ll want to contact your plan if you have any questions:

Allergies/Asthma

Pain

Inflammatory Conditions

High Blood Pressure

Mental Health

What does this mean for you?

When it comes to the conditions these medications can be prescribed to treat, you may have more options this year. Both national formularies still provide a list of covered alternatives as well.

What if your prescription is still on the exclusion list?

For more information and the full and current list of excluded drugs, see our post on the 2015 formulary changes. You can also find the list of changes for Express Scripts members here, and for Caremark members here.

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