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WARNING-2014 Prescription Exclusion List for ALL Express Scripts Subscribers

Discussion in 'Parents of Children with Type 1' started by moco89, Nov 1, 2013.

  1. mamattorney

    mamattorney Approved members

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    We are not express scripts subscribers and this still infuriates me (If I were, it would affect me personally, because I use Advair on a daily basis).

    @momofsweetone I've heard very good things about the Verio IQ from a t:slim group I belong to. Just remember it has to be charged. That could be a good thing or a bad thing depending upon your opinion.
     
  2. moco89

    moco89 Approved members

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    I don't know. I need to do a thorough search. There are some very recent publications on meter accuracy, but I do not know the specifics.

    ____________________________________________

    Here is a publicly available article evaluating the accuracy by meter, including the Verio Pro. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570841/

    From the Abstract: "Only two systems (systems A and B) fulfill the criteria of DIN EN ISO 15197:2003 with each test strip lot."


    Note: System A includes the Accu-Chek Aviva Strips, System B includes the Freestyle Lite Strips

    ___________________________________________
    Anyways, test strip variability, from lot-to-lot, seems to be an enormous issue surrounding accuracy. So, the test strips should be the major argument, not the meter choice. Although appealing is a huge hassle and causes grief, there is enough information to confirm that accuracy is very concerning and is a reason potentially worth appealling.

    You should be searching for things like "ISO" (for the International Standards Organization--which has updated, stringent accuracy standards--that the American Diabetes Association advocates for--for blood glucose measurement) and "glucose meter" on PubMed.

    An example would be "ISO glucose meter".
     
    Last edited: Nov 1, 2013
  3. moco89

    moco89 Approved members

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    I found information about the accuracy and precision of the Verio IQ meter evaluated under the ISO 15197:2003 standard. The meter appears to meet the ISO standard, when I quickly glanced at the data, in laboratory settings, when the meter company provided the test strips.

    Who really knows about the lot-to-lot variability on that particular meter, which is where the problem really lies.

    http://www.accessdata.fda.gov/cdrh_docs/reviews/K110637.pdf(page 9)
     
  4. caspi

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    It will be interesting to see what they do regarding the meters integrated with the pumps, most of which I believe use the strips that are now excluded.
     
  5. Beach bum

    Beach bum Approved members

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    Me too. We no longer use Express Scrips (thank goodness). Raise the prices if you have to, just don't say nope because you all can't play nicely in the sandbox together. That's what it all comes down to. The almighty $$$.

    I went through the list 4 items we use are on that list. I don't even think there is an alternative to Advair...
     
  6. momtojess

    momtojess Approved members

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    There is a small blurb that says it "applies to MOST expresscirpt drug lists; does not apply to medicare plans. "

    This is similar to what CVS/Caremark did last year.
     
  7. moco89

    moco89 Approved members

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    You better get stocked up...quickly. I would also get your doctor in on this immediately. I can tell you for a fact that appealing with them is a nightmare and will cause you grief. For me, I spent about 4 hours writing the appeal and assimilating the documentation. I easily spent over 10 hours on the phone dealing with Express Scripts--and they are very rude.

    You might be able to get your medical insurance company in on this too, especially if you have experienced significant expenses due to that particular medical problem. I just don't know the best way to approach them about this, or who to direct you to.

    I strongly recommend the book "Know Your Rights" by Jennifer Jaff Esq. that is a fundraising item for Advocacy for Patients / Jennifer Jaff Center, which is an amazing organization that deals with insurance issues. Unfortunately Jennifer passed away in 2012, but there are lawyers standing behind her organization serving patients in need.

    Anyways, that book is all you would ever need to know to in order to write an appeal. But, $30 is a lot of money for a book.
     
  8. Brenda

    Brenda Junior Member

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    First of all, I have no personal experience with Express Strips, understand why the changes are disturbing. When I was looking into this a few days ago, I found it interesting that Express Scripts was saying the products they are going to stop supplying were too costly yet this: http://online.wsj.com/news/articles/SB10001424127887324000704578388352407487648


    I did want to point out that the meter in New Zealand that has caused the uproar is the CareSens, manufactured in South Korea, not the One Touch. Please familiarize yourselves with the Strip Safely campaign (www.stripsafely.com).
     
  9. moco89

    moco89 Approved members

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    If you want to read about how awful (actually, incompetent, as megnyc said) Express Script's customer service is, if you encounter problems or have a problem, you will be in for quite a read.

    http://www.consumeraffairs.com/rx/express_scripts.html
     
  10. caspi

    caspi Approved members

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    I called my insurance company (Anthem BCBS) and spoke with a rep who connected me to an Express Scripts rep. She told me that if our strips are denied to request a prior authorization for an override first and then if that's denied, appeal.

    One thing I didn't think about until after I got off the phone was that we have a pre-authorization for 300 strips that's in effect until June, I believe. I wonder if that will still be honored then? Guess we'll just have to wait and see and deal with this come January. (Oh joy!) :rolleyes:
     
    Last edited: Nov 1, 2013
  11. moco89

    moco89 Approved members

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    I think you mean prior authorization for an override.

    The only reason for prior authorization is to ensure that the insurance company pays prior to the product or service being delivered.

    I do not like being so negative or pessimistic, but I deal with insurance issues constantly. I have a rare disease in which all treatments are essentially experimental, and I do not think you can avoid an appeal, although it is certainly worth a try.
     
    Last edited: Nov 1, 2013
  12. caspi

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    Sorry - I stand corrected. :eek:
     
  13. redheadmom

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    As far as stocking up on Apidra is concerned, you might want to call your dr. and see if they have any samples.

    I just talked to mine, and they have some that I'm going to go get. Apparently Apidra is not as commonly used by his patients as the other insulins, and so he doesn't use the Apidra samples as much as the other samples. It's worth a phone call, I think.
     
  14. MomofSweetOne

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  15. Megnyc

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    It's scary how large express scripts is. My parents and I went through all of our insurance options to see if we can avoid them. Insurance through my dad's employer (a large media corporation), my mom's employer (a university), my job (medium sized family owned business), and my college all only offer prescription drug coverage through express scripts.
     
  16. moco89

    moco89 Approved members

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    Well, I am really sorry. A lot of us are in similar situations, but maybe not as bad as yours. I suggest you start stocking up medication and getting samples from all of your doctors for the "excluded medications".

    This is pre-season. The games don't begin until you attempt to fill your prescription for the first time in 2014 and you get that denial letter. Anyways, appealing is time consuming but at the end of the day, you need X, Y, and Z prescriptions.

    Here is an article about Medco/Express Scripts and Anti-Trust from Forbes. http://www.forbes.com/sites/mergermarket/2013/04/08/how-medco-won-antitrust-approval-for-a-deal-wall-street-considered-doomed/
     
  17. BrendaK

    BrendaK Neonatal Diabetes Registry

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    We have not received a letter about any of this from them. How many of you have gotten letters in the mail? Wondering if we are affected. I'm assuming we are since we have Express Scripts for mail order. We only use them for insulin (and other nond supplies). We use A+ medical for test strips and pump supplies. A+ goes through durable medical, not pharmacy.
     
  18. sincity2003

    sincity2003 Approved members

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    Brenda,
    We have not received a letter either, but I'm thinking they're probably going out in waves and it just hasn't reached us. DS' Freestyle strips come through our DME coverage, and he's been on both Humalog and Novolog, so switching back isn't an issue. I guess I just worry, what's next that they will exclude?
    And also, if I'm reading correctly, they are the biggest pharmacy in the nation right? So how do the drug manufacturers feel about this? How do the pump companies feel about this? My employer does not use Express Scripts; however, their plans are priced out of my reach, with less coverage, so we use DH's plan with better medical coverage, but that forces us into using Express Scripts.
     
  19. mmgirls

    mmgirls Approved members

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    I received letters last week on Aprida and Freestyle. I was too pissed to do anything this week.

    Called to refill 1 month supply today and will submitt a 3month supply order in December.

    With that I will be well stocked, and will first try to see if my current DME/RX supplier can work their magic next year. If not I will sit back and see what others are doing. I am pretty sure I can count on my Dr to get us samples if need be.

    Where did the Tier system go? How is it possible that we would have to pay RETAIL for insulin for our Type 1 kids when we have health care coverage?
     
  20. ecs1516

    ecs1516 Approved members

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    I too find it unbelievable that it would be RETAIL. When we had United , Novolog was on its most experience Tier because they wanted everyone to switch to Humalog. So back then we paid the most expensive tier for Novolog. It almost seems they(insurance companies) are trying to get everyone to use Humalog. Humalog is made in the US I believe. Novolog from Europe . Not sure if that has anything to do with it. We have not received the letter yet...
     

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