Price of More Than 40 Prescription Drugs Will Rise in 2017

Two major pharmacy benefit managers—CVS Caremark and Express Scripts—serve 200 million Americans and plan to drop certain drugs from their formularies, causing the cost of those drugs to rise sharply January 2017.

The PBMs’ formularies determine which drugs make the cut for insurance companies, which helps the PBMs negotiate discounts with drug manufacturers. In short, policyholders who take prescription drugs will likely see changes regardless of their carrier.

“The drug companies do want to be on peoples’ formulary listings,” said Kathy Walsh from the State Department of Insurance. “So it is a balancing act, so that list could change next year.”

Some popular drugs on the list include Novacort, Nexium, Orencia, Crestor and Lantus.

The changes might not feel justified for the consumer who, for the first time, sees their prescription on the chopping block. A trip to the pharmacy might soon involve paying hundreds of even thousands of dollars out of pocket.

“There’s a lot of different steps people can take when facing those kinds of decisions,” said the Office of the Healthcare Advocate’s Demian Fontanella. “First is, talk to your doctor. That’s a key thing that most people don’t think about.”

Doctors know the choices patients have within their insurance plan, such as any generic versions, a different dosage, or any new drugs on the market.

If those alternatives are still too tough to swallow, policyholders should talk to their employer for ways they can appeal.

“As long as it’s a covered medication, the insurer could make a determination to cover it in a certain way to allow that member to continue to receive that benefit,” said Fontanella.

Click for links for the CVS Caremark formulary and Express Scripts formulary.

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