In the world of prescription drug insurance, there are medications that are covered by a health plan and some medications that are not covered. The list of drugs that are covered is known as the Prescription Drug Formulary (or “Formulary” for short).
What is a Prescription Drug Formulary?
If you’ve ever visited a pharmacy with a prescription in one hand and your insurance card in the other, only to be told that your medication is not covered by your insurance … but if your doctor is willing to change the prescription to a similar drug used to treat the same condition … you have first-hand experience of a Prescription Drug Formulary.
The formulary is a list of approved medications for which an insurer has agreed to help cover the cost. However, there might be multiple manufacturers of numerous drugs designed to treat the same condition. This is an opportunity for the insurance company to trim costs by only agreeing to cover one drug for each health condition.
For pharmaceutical manufacturers, this can be a very big deal to be included or excluded from an insurer’s formulary list. Accordingly, each health plan generally reviews its coverage list on an annual basis. This helps ensure they continue to get the best possible price-points for the competing medications that are available to treat high-cost health conditions.
For patients, this can mean that, each year, they may discover the drug they had been taking is no longer covered. This may require them to switch to an alternative medication to continue receiving help paying for the medication from their insurance provider.
Prescription Formulary Changes for 2019
At the time of this write-up, the calendar is fast approaching year-end, and new insurance plan-years for 2019. Many formulary lists are likely to change. Two of the largest managers of prescription drug formularies in the U.S. are Express Scripts and CVS Caremark. Here are the details of the medications these two companies are REMOVING from their lists for 2019:
If your medications are listed above (and if your insurer uses Express Scripts or CVS Caremark to manage their formulary) you can speak to your doctor or pharmacist about alternative medications designed to treat the same health condition. You can check these alternatives against your insurer’s new formulary list for 2019.
What If My Drugs Are Excluded?
It may also be worth double-checking the cash-price (i.e., the price without insurance) for your current medication. You can do this by clicking the drug name link in the list above. This can be a worthwhile effort, as the cash-price can often be lower than an insurance copay [Read more about Always Ask Cash Price]
What If I Can’t Switch to a Covered Alternative Drug?
If you’re unable to switch medications, you may be able to get some help from the FREE ScriptSave WellRx program. We negotiate savings on the cash-prices of medications at over 65,000 retail pharmacies across the United States. Patients can save up to 80% (relative to the cash price of their prescription).
Our price-check tool is available for free — no sign-up necessary. Go to www.wellrx.com or download the ScriptSave WellRx mobile app on iOS and Android to see how much you’ll save on your prescription costs!
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