Major Changes to Express Scripts Formulary Will Affect Many Asthma and Allergy Patients

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I just received notice that as of January 1, 2014, the Express Scripts formulary will be removing a number of medications from its repertoire of covered drugs. This means that patients under the Express Scripts plan will have NO COVERAGE for these prescriptions, and will be required to pay full price at the pharmacy. The list is long, and heavy on medications commonly used by patients with asthma and allergies:

Asthma medications:

Advair diskus
Advair HFA
Alvesco HFA
Flovent Diskus
Flovent HFA
Maxair Autohaler
Proventil HFA
Xopenex HFA

Allergy medications:

Auvi-Q
Beconase AQ
Omnaris
Rhinocort Aqua
Veramyst
Zetonna

As insurers continue to seek ways to cut costs and boost the bottom line, they will negotiate with pharmaceutical companies to obtain lower pricing. Those companies that play ball get to keep their drugs on the formulary. Those that don't, get dropped. The losers are the patients who will be required to switch from medications they have been taking successfully.

If you or a loved one are taking any of the medications on the above list, I would encourage you to schedule an appointment with your Board-Certified Allergist to discuss a trial of a covered alternative medication well in advance of January 1st. Your physician may have a sample of the new medicine that you can "try before you buy". You don't want to be in the position of being forced to switch before you've determined which alternative works for you. You may also want to take advantage of 90 day supplies of medication before the year ends and your coverage expires. Some of the soon to be excluded medications currently have manufacturer's coupons that will be valid through the end of the year.

Talk to your doctor -- we're here to help you navigate through the complex state of medical affairs.

Comments

  1. AnonymousNovember 14, 2013 at 9:58 AM

    Total Greed!

    ReplyDelete
  2. Alex RyuDecember 5, 2013 at 2:06 PM

    Hello Dr. Bajowala,

    Thank you for the wonderful post that explains the complexities of pharma pricing so clearly. I wanted to get in touch regarding a new educational asthma mobile game that might be of interest to you. I sent you a LinkedIn message but wanted to follow up in case you hadn't seen it. I hope to hear from you soon!

    All the best,
    Alex Ryu

    ReplyDelete
  3. UnknownMay 29, 2014 at 6:16 PM

    The politics of pharmaceutical companies sort of baffles me, to be honest. I suppose that's to be expected since I am on the ground level and they are thinking about millions of people at any given moment. But here is the problem with that disconnect! If they were taking those medications as well then there is no way they would pull that funding. I don't know whom is responsible.

    Nassim O'Shaughnessy | http://regionalallergycenter.com/

    ReplyDelete

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