With the back-and-forth on the battleground surrounding healthcare insurance, keeping up with what is and what isn’t included in your insurance when it comes to prescriptions can be difficult.
Especially now that Express Scripts and Caremark are dropping more than 80 prescriptions from their covered list at the end of 2017. However, they are including 20 previously excluded drugs in 2018.
Express Scripts and Caremark are, essentially, the companies from which your pharmacy benefits come from, even if you have insurance at UnitedHealthcare or Cigna and so on. So, if they’re changing their list of carried prescription drugs, then it could very likely impact your benefits.
For example, if your benefits come from one of the two companies and the drug you’re receiving is no longer on their list of included drugs, you’ll have to pay the full price for the drug starting in 2018.
If you believe this is the case, then you should speak to your doctor about potentially switching to an alternate drug that is covered by either Express Scripts or Caremark.
If that’s impossible, scroll down to the list below of excluded drugs and compare the price offered by eDrugSearch.com. Customers can save typically 50-90% off their medications when purchasing online. Check out eDrugSearch.com for further available savings on prescription medication.
The Big Changes in Express Scripts:
One of the most impactful changes concerns the epinephrine pen, Auvi-Q, and Adrenaclick, which are the main competitors to the EpiPen.
This could mean that purchasing epinephrine could become more expensive to purchase depending on what you use and how much you already pay. Adrenaclick is less expensive, being the generic brand, but it still starts just over $100.
Another worrying change concerns long-acting pain medication. Express Scripts will be removing Opana Er and the generic brand, oxycodone ER, as well as Lazanda, also known as fentanyl from their list of coverage prescriptions.
Since Abstral and Fentora are excluded already, your most likely to receive generic pain medication instead.
The Big Changes in Caremark:
For Caremark, 19 drugs have been added to their exclusion list, however, five of those are brands that have generic alternatives (making it cheaper) and others have several other options that treat similarly.
Where Caremark hits the hardest, however, are on Diabetes medications. Those drugs to be excluded are: Tanzeum, which is injectable. And SGLT2 inhibitors such as: Jardiance, Synjardy and Synjardy XR. All coverage will stop in 2018.
The Good News:
Although it may appear that affordable drugs are disappearing, in truth, a lot of the drugs being excluded are simply brand names being transitioned out for cheaper generic brands.
For example, 46 of the 64 drugs in Express Scripts that are being excluded have a cheaper generic alternative. In Caremark, five brands being excluded have generic alternatives.
This means that instead of having to pay high costs, you might actually find yourself paying even less. Provided, of course, that the prescription you require has a generic alternative available.
Caremark, also, is adding 19 drugs back to their included coverage list. Some are preferred medications while others non-preferred, which simply means that you may need Prior Authorization or step therapy to receive coverage.
Some of the items on this list don’t have generic alternatives, so Caremark is helping the coverage in that aspect. A few examples of the newly included prescription drugs are:
- Symbicort and Dulera for asthma and COPD inhalers.
- As well as medications for erectile dysfunction like Incruse Ellipta and Levitra.
- There are two for Diabetes as well: Invokana and Invokamet.
To further your benefit, you can easily compare your medication prices by using eDrugSearch.com. This will allow you to ensure that you’re only paying what you need to and not inflated prices elsewhere.
The site offers free comparison and you can save around 50%-80% instantly. You can utilize this tool in the wake of your medication no longer being carried by Caremark or Express Scripts and still receive a good deal on your prescriptions.
Medicare & Individual Plans:
For those with Medicare, these changes do not apply to you. However, if your Medicare benefits are conducted by Express Scripts or Caremark, you should double check your coverage. You can do this either with your pharmacist or simply by going online here.
Similarly, those with individual plans may also be impacted, depending on the medication in question, and if your benefits go through either Express Scripts or Caremark. This includes the insurance you receive at work.
If you’re unsure even in the slightest, it is best to double check with your pharmacy or insurance, so you don’t find yourself with an expensive bill the next time you fill a prescription.
2018 Excluded Medications:
Below is a list of the excluded medications from both Express Scripts and Caremark. Not all are shown, please check the Express Script list here and the Caremark list here for the complete list of medications no longer included in their coverage.
Effexor XR (Both)
epinephrine (generic Adrenaclick) (Express Scripts)
Minastrin 24 Fe (Express Scripts)
Opana ER (Express Scripts)
Oxycodone ER (Express Scripts)
Plaquenil (Express Scripts)
Plavix (Express Scripts)
Prevacid (Express Scripts)
Prilosec (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 XR (Caremark)
Wellbutrin SR (Express Scripts)
Xanax (Express Scripts)
Xanax XR (Express Scripts)
Xenazine (Express Scripts)
How Will This Affect You?
Scroll down and let us know in the comments below.