Author Topic: CVS Caremark drops 3 big-name MS drugs from 2017 formulary  (Read 124 times)

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Offline agate

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CVS Caremark drops 3 big-name MS drugs from 2017 formulary
« on: August 17, 2016, 10:27:33 am »
A blogpost from Multiple Sclerosis News Today, August 17, 2016:

CVS Prescription Plan Drops Big Name MS Drugs from 2017 Formulary

 Laura Kolaczkowski

The CVS Caremark covered insurance plan has dropped Avonex, Plegridy and Extavia, three multiple sclerosis disease-modifying therapies, from their 2017 formulary.

You say, OK, but what does that really mean? If your prescription insurance is through CVS Caremark, and you want one of those drugs or one of the other 130 that were announced as off their formulary for next year, you can still get it, but you have to pay the full price.  Your CVS Caremark insurance will no longer cover those costs unless your doctor is able to successfully appeal the formulary decisions.

Why would CVS do this? The bottom line is company profits for the stakeholders. CVS Health’s statement to their stockholders and clients reads:

“CVS Health is taking a stand against egregious drug price increases that unnecessarily add costs for clients and their members. On a quarterly basis, products with egregious cost inflation that have readily-available, clinically-appropriate and more cost-effective alternatives may be evaluated and potentially removed from the formulary. For example, among the hyperinflationary drugs that will be removed in 2017 is Alcortin A External Gel by Novum Pharmaceuticals which saw a price inflation of 2,856.8 percent in the last three years.

“Our rigorous approach to formulary management will help generate a total savings of more than $9 billion for clients from 2012 through 2017.”


This is nothing new for expensive drugs to be removed from the formulary (those lists of approved and covered drugs). It was only a few years ago that Rebif was booted from one list, but they regained approval the following year. Excluding drugs from the formulary is a way that drug insurance providers will use to force a better discount from the drug manufacturer. It is also used to force consumers to accept generic over brand-name drugs.

It might be worth your time to look over the list if you are one of the 85 million customers of CVS Caremark insurance to see if any of your other drugs are also off the list. You can read the entire group of 130 drugs and see it includes those in many disease areas, including HIV and cardiac care.

If you happen to be among the unfortunate people who take one of these drugs and are a customer of CVS Caremark, you should be talking with your doctor now about options.  Sometimes the drug plan coverage will grant exceptions, but it takes a lot of paperwork and time to complete and that needs to begin now and not in January 2017.
MS Speaks--online for 13 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010.


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