Announcement

Collapse
No announcement yet.

CVS Insurance Plans Removing MS (and other) Drugs Due to Cost

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

    CVS Insurance Plans Removing MS (and other) Drugs Due to Cost

    If you have a prescription drug plan that is fulfilled by CVS/Caremark, several MS drugs will soon be excluded. CVS will still carry the medication, but it is dropping it from the formulary for insurance purposes. Since 2012, the list of excluded drugs has ballooned from 34 to 124 in 2016. Similarly, CVS's bigger prescription drug insurance rival Express-Scripts (ESRX) has banned 90 drugs from its coverage.

    Most of the press coverage is about Viagra also being excluded.

    Here are the MS drugs that CVS is dropping from its coverage in 2016:
    • Avonex
    • Extavia
    • Plegridy


    Other drugs that will be excluded in 2016 include:
    1. Abilify (antipsychotic)
    2. Amitiza (irritable bowel disease)
    3. Bydureon (diabetes)
    4. Carac (dermatology)
    5. Cardizem, including Cardizem CD, Cardizem LA and its generic (high blood pressure)
    6. Clobetasol spray (dermatology)
    7. Clobex spray (dermatology)
    8. Cymbalta (depression)
    9. Diovan (high blood pressure)
    10. Exforge, including Exforge HCT (high blood pressure)
    11. Fluorouracil cream 0.5% (dermatology)
    12. Fortesta (testosterone replacement)
    13. Fosrenol (kidney disease)
    14. Incruse Ellipta (Chronic obstructive pulmonary disease)
    15. Intuniv (ADHD)
    16. Invokameet (diabetes)
    17. Invokana (diabetes)
    18. Matzim LA (high blood pressure)
    19. Monovisc (monovisc)
    20. Noritate (dermatology)
    21. Qsymia (anti-obesity)
    22. Relistor (gastrointestinal)
    23. Valcyte (anti-infective)
    24. Viagra (erectile dysfunction)
    25. Zubsolv (opioid dependence)

    #2
    Hey Marco,

    Well that's an interesting action by CVS. So they're dropping 3 interferons...makes you wonder
    when they'll drop the others, and why these three.

    I've run into an interesting situation with one of my meds. I use Clonazepam for upper body spasticity (i.e. what the pump doesn't cover.) Anyhoo...they're backordered, not at a particular
    pharmacy, but at the manufacturer's level. It's probably been a month already, and they don't have a date to expect it. My neuro said he'd never heard of that happening, but they called the
    pharmacy and it seems like the higher dosages aren't backordered, so they prescribed a higher dosage and I have to cut them down. When I picked up my Rx for the Clonazepam total was $2.40. Since there's probably very little profit in that med it makes me wonder if that could be
    a reason for the backorder. The neuro and the pharmacist were clueless as to why the long wait.

    Back to Avonex, and the others, if they're not covered in the formulary, does that mean you have
    to pay full price if you want the med? I don't think too many people have $3K to spare each month. That means it would force you to buy another med, does the pharmacy make more money on the other MS meds? All questions that would be interesting to get the answers to?

    Follow the money $$$....I saw the Fugitive, it's the drug companies behind it all. Just kidding of course, but an explanation would be nice. Have they made one?

    Comment


      #3
      I can assure you this is ALL about money. The insurance company is probably not profiting more, but spending less (cost avoidance) on formulary medications. My guess is Betaseron and Rebif agreed to accept lower reimbursement amounts. Extavia and Biogen (Avonex & Plegridy) probably balked at lower pricing so they got axed from the formulary.
      • Keep in mind that Extavia and Betaseron are the identical medication.
      • Avonex and Rebif are the same medication with different dosing.
      • While Plegridy is different, it is still based on Avonex.


      If I was on one of these medications provided by CVS/Caremark I would contact the pharmaceutical company immediately and ask for their guidance. They may provide the medication to you at a discounted, or even free, rate. If financial arrangements cannot be made, I would contact my neurologist for an appointment. Since it normally takes 2-4 weeks to start a new medication, you need to have a new one lined up no later than Thanksgiving.

      If CVS/Caremark Specialty pharmacy currently insures and dispenses Avonex, Plegridy or Extavia you will need to:
      • contact your pharmaceutical company (1-800-456-2255 for Avonex or Plegridy, and 1-866-398-2842 for Extavia)
      • request an exception to policy from CVS/Caremark (highly doubtful)
      • select a new medication
      • pay the full amount out of pocket (don't do this)

      Comment


        #4
        CVS Lawsuit

        A lawsuit was filed last week against CVS for deliberating overcharging generic drugs for customers with health insurance.

        Comment


          #5
          It's pretty amazing the difference in pricing between countries for MS drugs, among others.

          In NZ our govt buying agency (Pharmac) assesses the efficacy of drugs and if they stack up, negotiates a price with the drug company that they are prepared to pay. If the drug companies don't play ball, Pharmac doesn't buy the drug. Although we don't have access to quite the same volume of drugs, we still do ok.

          Interestingly, the cost to the govt of the MS drugs is about a third of what you pay in the US, and the maximum we are charged for them is US$3.70 per month.

          Comment


            #6
            I read about this.

            Do you think they have dropped Avonex (and others?) injectables because of an increase in the use of oral medications?

            Comment

            Working...
            X