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Express Scripts National Formulary cuts novolog/apidra/and novolin9regular) - excluded status for 20

Discussion in 'Parents of Children with Type 1' started by siren, Nov 3, 2014.

  1. siren

    siren Approved members

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    UPDATE: According to wwwdotfiercepharma on Oct 29,2014, and other web publications, CVSCaremark will continue Novolog in its formulary for 2015 and there may be others. Express Scripts is the only one who refused to renew NovoNordisks' contracts for Novolog when the Danish maker declined to give them the discounts they wanted. Its a question of pricing.ExScripts gave the contract to Lilly, maker of Humulog, based solely on price.It affects about 600,000 customrs or about 2%. There is talk of a diabetes drug pricing battle afoot that could extend to lantus in the not to far out future. big Pharma pricing has been an issue in this country, but for now its the patient that will be squeezed if the med that works for them is cut off by Rx benefits companies exerting pressure on pharma companies, as Express Scripts has done last year and this year.


    Hi all,

    I recently received a letter from my insurance company regarding their switch to Express Scripts National Formulary effective 2015 plan year. What shocked me was the news that Express Scripts has put Novolog and Apidra on the list of EXCLUDED medications on their National Formulary for 2015. In a call to them at 1(877)438-4449, the only number my insurer gave to all, the friendly gentleman at the other end read from a script saying Express Scripts had a meeting of doctors and themselves and decided for cost savings and quality of care to cut Novolog, Apidra, Novolin or regular, Abbott(FreeStyle/Precision) from the list of covered insulin and testing supplies. So it is not even available at the higher copay, it is excluded.

    The take away is that you may want to recheck your insurance coverage for the Rx benefits for the coming year. If your plan uses Express Scripts National Formulary, and not an Ex Scripts formulary specifically tailored to your insurance plan, you may want to recheck your insurance coverage for the coming year if you want to keep using Novolog. Otherwise its full retail price for it.

    Just passing this along. I doubt they used a pediatric endocrinologist for this decision. We switched to Novolog years ago after finding the silhouette sets lasted the full 3 days as opposed to two days with Humulog. They are regarded as the same but that is not quite what we found after going on the pump.
     
    Last edited: Nov 4, 2014
  2. redheadmom

    redheadmom Approved members

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    I'm pretty sure you can get that waived. My Express Scripts policy had Apidra on the exclusion list for this year (2014). However, all I had to do was get a form from Express Scripts, have my doctor fill it out stating the reason why Apidra was superior for me, and mail it in. And it was approved within a week. They did this for my excluded test strips, too. So I've had coverage of both excluded prescriptions all year (although both are in the uppermost copay.)
     
  3. siren

    siren Approved members

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    Jun 28, 2007
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    Hi Linda,

    But that is an unnecessary hurdle for thousands and thousands who are using novolog and prefer it to humulog. The letter explicitly states if the drug is on the excluded list you will pay the retail price. There was nothing about any review committee appeal. Though Express Scripts does have an appeals phone number, they did not include that in this letter or any wording about appeals.
    We found there are differences in the two insulin meds when using a pump. Sets did not last as long, parents complained of increased clogging of cannula, sites lasted 2 days instead of three was our issue and others across a large geographic area complained about this too. Switching to Novolog ended that. We had fewer bad sites, they lasted the three days and we used fewer silhouettes, fewer needle sticks, better Bg management. For the company to say this cut is to improve care and cut costs flies in the face of the experience of many with Humulog.
    Novolog is an important alternative for people that humulog doesn't work for. it has properties the committee at Express Scripts appears to have no knowledge of or failed to take into consideration in their decision to leave those they serve with one short acting insulin and no alternate. Appeals may help but they should have kept Novolog and Apidra preferred, at the high copay if necessary, as opposed to an out right exclusion. Telling everyone they will have to pay retail if they want it in the letter that went out health plan members failed to tell members what their options are, no information on appeals.
     

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