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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. mom2Hanna

    mom2Hanna Approved members

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    I am apparently late to this party, just got a letter today about my daughters freestyle test strips. Interestingly, it made no mention of her novalog.
     
  2. sincity2003

    sincity2003 Approved members

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    If she gets NovoLog, I woudn't hold your breath that you are still getting it. We got 5 individual letters, one for each prescription they would no longer cover, that came over a period of 4 days.
     
  3. Debdebdebby13

    Debdebdebby13 Approved members

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    Just bumping this up since we got our letter today. I can deal with the Humalog switch, but with DD on Omnipod I REALLY don't want to switch test strips. I guess I need to call Edgepark and see if we can get her test strips covered under DME. I don't really understand that, but I will see what I can do. We pay a boatload for Freestyle strips from the pharmacy anyway, maybe they'll be cheaper through Edgepark.
     
  4. swellman

    swellman Approved members

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    Express Scrips is a $10 copay for Verio IQ - I get 1100. Personally, I was glad and jumped on it.

    I haven't heard about Novolog yet and have a 3 month supply but I will get bent when they tell me I can't get it.
     
  5. MomofSweetOne

    MomofSweetOne Approved members

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    This is determined by your insurance plan. We pay $50 for the same amount from Express Scripts.
     
  6. sincity2003

    sincity2003 Approved members

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    And for us, that same amount is $365 :eek: which is why we do our test strips through DME. However, starting January 1st, they will be a little cheaper because our plan is changing. I wish we had $10 copays again :(
     
  7. MHoskins2179

    MHoskins2179 Approved members

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    Just make sure to clearly understand that you can still get whatever the supply or medication is you might want -- there's a process through Express Scripts that will allow that and will likely involve your doc providing the "medically necessary" paperwork to get the pre-auth/override.

    From Express Scripts corporate communications head, David Whitrap:

    "If a patient has a medical need for one of the insulin brands that are not 'covered' under their formulary, then we will ensure that that patient still has access to that product. We are able to supply products in addition to those listed on our formulary."

    If you want it, fight for it -- especially in the beginning of 2014, as this will make it known to those within ExpressScripts what might need to be changed in their new policy based on those making the most noise.
     
  8. swellman

    swellman Approved members

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    Yea, I guess I should have said Tier 1 instead of Tier 3 like the Freestyle. Maybe that varies by plan as well.
     
  9. NeurosurgeryNP

    NeurosurgeryNP Approved members

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    I was told Edgepark no longer contracts with Abbott for the freestyle strips about two months ago. Therefore they won't send them to me. Apparently they cost too much for what my insurance reimburses them for.
     
  10. Thornbird

    Thornbird Approved members

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    Wow, how did I miss this until now? We haven't received a single letter from Express Scripts as others have mentioned (for Novalog or Freestyle strips). Hopefully I can get a refill on both before Jan 1.

    This may be of interest to other Omnipod users: when we switched from MDI/One Touch meter to the Omnipod system in August, their rep informed me that Insulet would pay whatever extra cost we would incur by switching to the Freestyle test strips.

    We received a card in the mail from Freestyle that we present to the pharmacy, and they give us the strips at the same rate we were paying before. (We didn't have a copay with the One Touch strips, so we haven't had one with the Freestyle, either, since the "price match" card.)
     
  11. NeurosurgeryNP

    NeurosurgeryNP Approved members

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    I believe the promise card only covers up to a maximum of $50 of your copay.
     
  12. caspi

    caspi Approved members

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    We never did receive a letter and we also received a notice from them last month when our strips were up for renewal that they were approved for another year, until November 2014.
     

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