How to Save on Prescription Drugs If Your Coverage Recently Dropped

Healthcare News

How to Save on Prescription Drugs If Your Coverage Recently Dropped

Uninsured
RxSaver Editors
By RxSaver Editors
Jul 01, 2018 - Updated Aug 20, 2018
A photo of different bright and colorful pills

Formulary exclusion lists inform you what medications your insurance will be removed from coverage.

Drug formulary exclusion lists outline the medications an insurance plan will remove from coverage. Formularies identify the drugs available for certain conditions and organizes them into cost levels, known as tiers. Formularies often give you choices, so you and your doctor can choose what the best treatment option is for you.

RxSaver can help you find out if you’re overpaying for your medications. Prescription prices vary by pharmacy location and also by which discount source is used, i.e. Rx coupons or health insurance. Comparing Rx prices is important to ensure you’re not overpaying.

Use the RxSaver tool below to search discounted coupons at nearby pharmacies.

Formulary lists generally change annually, but can also be updated semi-annually. Changes typically occur when a medication moves to a lower or a higher tier (when its generic becomes available). Exclusions most often occur when a lower cost generic version become available.

Scroll down to view the Formulary Exclusions List

What is a drug formulary?

Drug formularies are lists of medications covered by insurance plans. Pharmacy Benefit Managers (PBMs) work closely with insurance companies to determine what medications their plans will cover.

Express Scripts has said their formulary is designed to bring the greatest value to their clients and members while increasing the use of the lowest net-cost products. Express Scripts claims the updates to their formulary will save payers and their members $3.2 billion on their prescription drug bill.

Always shop around for your medications

All hope isn’t lost if you find your medication on the updated formulary exclusions list. Since drug prices vary by pharmacy location and also by which insurance is used, you can often find deals on your medication costs. Using tools, like RxSaver, you can find which pharmacy has the lowest price for your medication. You can also use the RxSaver search tool to find out if there is a generic equivalent for your medication.

Why are some drugs excluded from formulary coverage?

Medications may be excluded from coverage when a biosimilar prescription, generic alternative, or over-the-counter (OTC) medication becomes available.

Why do I need to know if my formulary has changed?

It’s important to know if your formulary is expected to change in the coming year, so you can start planning for what you will do if your drug’s coverage is dropped.

What can I do if my drug is dropped from my insurance’s drug formulary?

If a drug’s coverage is dropped from your insurance’s formulary, there are a few things you can do:

1: Perform a simple search on RxSaver. By doing this, you can find coupons for your medication and ensure you’re not overpaying at the pharmacy counter.

2: Find out if there is a generic version of your medication available. A simple search on RxSaver can help you identify this. Drug companies often modify their formulary, when a less expensive version of the medication, like a low-cost generic, becomes available.

3: Talk to your physician about treatment options. Are there other medications your doctor can write a prescription for?

CVS/Caremark Formulary Exclusions

Updated July 2018.

CVS/Caremark announced the following exclusions on July 1, 2018. The announcement indicates drug exclusions begin immediately. The CVS/Caremark announcement says “If you continue using one of the drugs listed below and identified as a Formulary Drug Removal, you may be required to pay the full cost.”

CVS/Caremark states they remove drugs only when clinically-appropriate, lower-cost (often generic) alternatives, are available. They indicate their targeted approach ensures minimum member disruption. The company estimates that 99.76 percent of members should not be affected by the formulary changes.

A - K

Abilify
– Accu-Chek Strips and Kits 6
Actemra
Actos
Adderall XR
– Aerospan
Alcortin A
– Alevicyn Gel
– Alevicyn Kit
– Alevicyn SG
– Alevicyn Solution
– Allison Medical Insulin Syringes 4
– Aloquin
Altoprev
Alvesco
Amrix
Androgel 1%
– Apexicon E
Apidra
– Arthrotec
Asacol HD
Atacand
Atacand HCT
Beconase AQ
Benicar
Benicar HCT
– Bensal HP
Betapace
Betapace AF
– Breeze 2 Strips and Kits 6
Butalbital-Acetaminophen-Caffeine Capsule
– Bydureon
Byetta
Cafergot
Carac
Cardizem
Cardizem Cd
Cardizem La (and its Generics)
Carnitor
Carnitor SF
Cimzia
– Clobetasol Spray
Clobex Spray
Colazal
– Contour Next Strips and Kits 6
– Contour Strips and Kits 6
Crestor
– Cymbalta
– Daklinza
– Delzicol
– Detrol LA
– Dexpak
Diovan
Diovan HCT
Doryx
Doryx MPC
Dulera
Dutoprol
Dyrenium
Edarbi
Edarbyclor
– E.E.S. Granules
Effexor XR
Elelyso
Enablex
Entyvio
– Eryped
Euflexxa
Evzio
Exforge
– Exforge HCT
Extavia
Fanapt
– Fioricet Capsule
– Fluorouracil Cream 0.5%
– Follistim AQ
Fortamet
Fortesta
Fosrenol
– Freestyle Strips and Kits 6
Genotropin
Gleevec
Glumetza
– Helixate FS
Horizant
Humalog
Humalog Mix 50/50
Humalog Mix 75/25
– Humulin 70/30 3
– Humulin N 3
– Humulin R 3
Hyalgan
Indocin
Intermezzo
Intuniv
Jalyn
Jardiance
Kazano
Kineret
Kombiglyze XR

L - Z

Lanoxin Tablet (125 Mcg & 250 Mcg)
Lantus
Lescol XL
Lipitor
Livalo
Lunesta
Macrodantin
Matzim LA
Mavyret
Miacalcin Injection
– Miacalcin Nasal Spray
Millipred
Minocin
– Monodox
– Monovisc
Naprelan
Natesto
Nesina
Neupogen
Nexium
Nilandron
Noritate
Norvasc
Novacort
– Novo Nordisk Needles 4
– Nutropin AQ
Nuvigil
– Oleptro
Olux-E
– Olysio
Omnaris
Omnitrope
Onglyza
Orencia Clickject
– Orencia Intravenous
– Orencia Subcutaneous
Orthovisc
Oseni
– Owen Mumford Needles 4
Oxytrol
Pennsaid
– Perrigo Needles 4
Plavix
Pradaxa
Praluent
Pred Forte
Prevacid
Primlev
Protonix
Proventil HFA
Qnasl
Qsymia
Rayos
Relistor
Rimso-50
Riomet
Rozerem
Saizen
Seroquel XR
Simponi
Sprix
Stendra
– Sumavel Dosepro
– Synerderm
Synjardy
Synjardy XR
Synvisc
Synvisc-One
Taltz
– Tanzeum
Tasigna
– Technivie
Testim
– Testosterone Gel 1% 7
Tobi
Tobi Podhaler
– Toujeo
Tricor
– Trividia Insulin Syringes 4
– Tudorza
– Ultimed Insulin Syringes 4
– Ultimed Needles 4
Uroxatral
Valcyte
Valtrex
Vanoxide-HC
– Venlafaxine Ext-Rel Tablet (Except 225 Mg)
– Venlafaxine Ext-Rel Tablet (Except 225 Mg)
Ventolin HFA
Viagra
– Viekira Pak
Vogelxo
Xeljanz
Xeljanz XR
Xenazine
Xopenex HFA
Zegerid
Zepatier
Zetia
Zetonna
Zonegran

Express Scripts’ Formulary Exclusions

Updated August 2018. The changes to Express Scripts’ formulary will begin January 1, 2019.

A - M

– Abbott (Freestyle, Precision)*
– Alcortin A
– All other meters & strips that are not Lifescan Brand
– Alocril
– Alomide
– Altoprev
– Atripla
– Bayer (Breeze, Contour)*
– Berinert
– Brovana
– Chorionic Gonadotropin
– Climara Pro
– Contrave ER
– Cortifoam
– Daklinza*
– Duzallo
– Eloctate
– Emadine
– Embeda
– Extavia
– Fenoprofen (capsule)
– Fenortho
– Flarex
– FML Forta
– FML S.O.P.
– Humatrope
– Lupron Depot-ped
– Mavyret
– Maxidex

N - Z

– Nalfon
– National Medical (Advocate)*
– Neupro Patch
– Nutropin AQ Nuspin*
– Olysio*
– Omnis Health (Embrace, Victory)*
– Omnitrope*
– Oxycodone ER*
– Pradaxa
– Pred Mild
– Pregnyl
– Qsymia
– Recombinate
– Roche (Accu-chek)*
– Saizen*
– Saizenprep*
– Savaysa
– Sovaldi*
– Topicort Spray
– Trividia (Truetest, Truetrack)*
– Unistrip*
– Verdeso Foam
– Xadago
– Xerese Cream
– Xyntha
– Xyntha Solofuse
– Zomaction*
– Zurampic
– Zypitamag*

Multi-source Brand Exclusions

The generic equivalents of the following brand-name medications are covered on the NPF.

– Brisdelle
– Namenda XR
– Norco
– Nuvigil
– Uroxatral
– Vagifem
– Viagra
– Vivelle-dot
– Yasmin
– Zonegran


*Current 2018 exclusions in this class

The Express Scripts exclusions go into place on January 1st, 2019.

RxSaver Editors

RxSaver Editors

RxSaver Editors are wellness enthusiasts who help you learn how you can save the most on prescription medication costs and other health-related topics.

The information on this site is generalized and is not medical advice. It is intended to supplement, not substitute for, the expertise and judgment of your healthcare professional. Always seek the advice of your healthcare professional with any questions you may have regarding a medical condition. Never disregard seeking advice or delay in seeking treatment because of something you have read on our site. RxSaver makes no warranty as to the accuracy, reliability or completeness of this information.

If you are in crisis or you think you may have a medical emergency, call your doctor or 911 immediately.