Formulary exclusion lists inform you what medications your insurance will be removing from coverage.
Drug formulary exclusion lists outline the medications an insurance plan will remove from coverage. Formularies identify the drugs available for certain conditions and organizes them into cost levels, known as tiers. Formularies often give you choices, so you and your doctor can choose what the best treatment option is for you.
Use RetailMeNot Rx Saver to see if you’re overpaying for your medications
RetailMeNot Rx Saver can help you find out if you’re overpaying for your medications. Prescription prices vary by pharmacy location and also by which discount source is used, i.e. Rx coupons or health insurance. Comparing Rx prices is important to ensure you’re not overpaying.
Formulary lists generally change annually, but can also be updated semi-annually. Changes typically occur when a medication moves to a lower or a higher tier (when its generic becomes available). Exclusions most often occur when a lower cost generic version become available.
Scroll down to view the Formulary Exclusions List
What is a drug formulary?
Drug formularies are lists of medications covered by insurance plans. Pharmacy Benefit Managers (PBMs) work closely with insurance companies to determine what medications their plans will cover.
Express Scripts has said their formulary is designed to bring the greatest value to their clients and members, while increasing the use of the lowest net-cost products. Express Scripts claims the updates to their formulary will save payers and their members $3.2 billion on their prescription drug bill.
Always shop around for your medications
All hope isn’t lost if you find your medication on the updated formulary exclusions list. Since drug prices vary by pharmacy location and also by which insurance is used, you can often find deals on your medication costs. Using tools, like RetailMeNot Rx Saver, you can find which pharmacy has the lowest price for your medication. You can also use the Rx Saver search tool to find out if there is a generic equivalent for your medication.
Why are some drugs excluded from formulary coverage?
Medications may be excluded from coverage when a biosimilar prescription, generic alternative, or over-the-counter (OTC) medication becomes available.
Why do I need to know if my formulary has changed?
It’s important to know if your formulary is expected to change in the coming year, so you can start planning for what you will do if your drug’s coverage is dropped.
What can I do if my drug is dropped from my insurance’s drug formulary?
If a drug’s coverage is dropped from your insurance’s formulary, there are a few things you can do:
1: Perform a simple search on Rx Saver. By doing this, you can find coupons for your medication and ensure you’re not overpaying at the pharmacy counter.
2: Find out if there is a generic version of your medication available. A simple search on Rx Saver can help you identify this. Drug companies often modify their formulary, when a less expensive version of the medication, like a low-cost generic, becomes available.
3: Talk to your physician about treatment options. Are there other medications your doctor can write a prescription for?
CVS/Caremark Formulary Exclusions
Updated July 2018.
CVS/Caremark announced the following exclusions on July 1, 2018. The announcement indicates drug exclusions begin immediately. The CVS/Caremark announcement says “If you continue using one of the drugs listed below and identified as a Formulary Drug Removal, you may be required to pay the full cost.”
CVS/Caremark states they remove drugs only when clinically-appropriate, lower-cost (often generic) alternatives, are available. They indicate their targeted approach ensures minimum member disruption. The company estimates that 99.76 percent of members should not be affected by the formulary changes.
-Accu-Chek Strips and Kits 6 Actemra
-Allison Medical Insulin Syringes 4 Aloquin
-Breeze 2 Strips and Kits 6 Butalbital-Acetaminophen-Caffeine Capsule Bydureon
-Cardizem La (And Its Generics) Carnitor
-Contour Next Strips and Kits 6 Contour Strips and Kits 6 Crestor
-Fluorouracil Cream 0.5%
-Freestyle Strips and Kits 6
-Humalog Mix 50/50
-Humalog Mix 75/25
-Humulin 70/30 3
-Humulin N 3
-Humulin R 3
-Lanoxin Tablet (125 Mcg And 250 Mcg Only) Lantus
-Miacalcin Nasal Spray
-Novo Nordisk Needles 4
-Onglyza Orencia Clickject Orencia Intravenous Orencia Subcutaneous Orthovisc
-Owen Mumford Needles 4
-Perrigo Needles 4
-Testosterone Gel 1% 7
-Trividia Insulin Syringes 4
-Ultimed Insulin Syringes 4
-Ultimed Needles 4
-Venlafaxine Ext-Rel Tablet (Except 225 Mg) Venlafaxine Ext-Rel Tablet (Except 225 Mg) Ventolin HFA
Abbott (Freestyle, Precision)*
All other meters & strips that are not Lifescan Brand
Bayer (Breeze, Contour)*
National Medical (Advocate)*
Nutropin AQ Nuspin*
Omnis Health (Embrace, Victory)*
Trividia (Truetest, Truetrack)*
Multi-source Brand Exclusions
The generic equivalents of the following brand-name medications are covered on the NPF.
*Current 2018 exclusions in this class
The Express Scripts exclusions go into place on January 1st, 2019.