Close up of prescription drug medicine bottles

Prescription Drugs Increasingly Excluded From Insurance Coverage

Prescription insurers such as CVS Caremark and Express Scripts are increasingly taking drugs off of their lists of approved medications, NPR.org has reported.

CVS Caremark and Express Scripts, the biggest prescription insurers, have made their lists of approved and excluded medications for 2017 open to the public.

Some of the excluded drugs include those that treat arthiritis, diabetes, hepatitis, and cancer, along with Proventil and Ventolin, commonly prescribed brands of asthma inhalers.

According to NPR, if the manufacturers won’t give the prescription insurers big discounts, they put the drug on its “we won’t pay” list. CVS Caremark has listed about 130 drugs on this list, and Express Scripts has listed about 85.

“We’ve talked to dozens and dozens of people who find themselves at the pharmacy counter, shocked to find out that the drug is no longer covered,” says Lisa Gill, an editor at Consumer Reports’ “Best Buy Drugs.”

For some of the medications excluded, these companies will pay for alternatives known as biosimilars. However, biosimilars aren’t exact replications of the medications they replace. When the excluded drugs don’t have generic alternatives to be immediately substituted with, patients have to go back to their doctor to get a prescription for a new drug. It could be a small inconvenience for some patients, or it could become a real medical issue for patients with time restrictions, or if the drug on the approved list doesn’t work as well for the patient as the one that’s been kicked off.

To read more about this issue visit npr.org.

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