90+ Medications To Be Dropped by Insurance in 2019

Drugs excluded includes brand-name drugs for which less expensive brand or generic alternatives are available in the market…………………………………..

By Benita Lee

Benita Lee, MPH, is on the Research Team at GoodRx.

November 1, 2018

Every year, insurance plans update the list of drugs that they cover, also known as their formulary. That means that some drugs covered this year won’t be covered next year. (In fact, more and more drugs are excluded from formularies each year.) And drugs that are new to the market might be covered soon. If you rely on health insurance to pay for your medications, now’s a good time to pay attention.

Express Scripts and Caremark, companies that handle pharmacy benefits for more than 200 million Americans, are removing more than 90 medications from their formularies at the end of 2018. That means that prescription drug coverage for you will likely change too.

What are Express Scripts and Caremark?

Express Scripts and Caremark are pharmacy benefit managers (PBMs) that administer prescription drug benefits for many health insurance companies and TRICARE. While you may have health insurance from Anthem, Aetna or another insurer, your pharmacy benefits are usually handled by these PBMs or their competitors. PBMs also set the formulary for everyone under their prescription drug benefit.

2019 Excluded Drugs

Below are Express Scripts and CVS Caremark’s newly excluded drugs for 2019. If you’re not sure which PBM provides your pharmacy benefits, contact your insurance plan administrator.

Acanya (Caremark)
Acticlate (Caremark)
Alcortin A (Express Scripts)
Alocril (Express Scripts)
Alomide (Express Scripts)
Altoprev (Express Scripts)
Atripla (Express Scripts)
Levicyn (Caremark)
Alprolix (Caremark)
Avenova (Caremark)
Benzaclin (Caremark)
Berinert (Express Scripts)
Brisdelle (Express Scripts)
Brovana (Express Scripts)
Cambia (Caremark)
Chorionic Gonadotropin(Express Scripts)
Climara Pro (Express Scripts)
Contrave ER (both)
Cortifoam (Express Scripts)
Daklinza (Express Scripts)
Duzallo (Express Scripts)
Eloctate (both)
Emadine (Express Scripts)
Embeda (Express Scripts)
Extavia (Express Scripts)
Fasenra (Caremark)
Fenoprofen (capsule) (Express Scripts)
Fenortho (Express Scripts)
Flarex (Express Scripts)
FML Forte (Express Scripts)
FML S.O.P. (Express Scripts)
Humatrope (Express Scripts)
Invokamet (Caremark)
Invokamet XR (Caremark)
Invokana (Caremark)
Jentadueto (Caremark)
Jentadueto XR (Caremark)
Lazanda (Caremark)
Levorphanol (Caremark)
Lupron Depot-Ped (Express Scripts)
Mavyret (both)
Maxidex (Express Scripts)
Nalfon (Express Scripts)
Namenda XR (Express Scripts)
Neupro patch (Express Scripts)

Norco (Express Scripts)
Norditropin (Caremark)
Nutropin AQ Nuspin (Express Scripts)
Nuvigil (Express Scripts)
Olysio (Express Scripts)
Omnitrope (Express Scripts)
Onexton (Caremark)
Oxycodone ER (Express Scripts)
Pradaxa (Express Scripts)
Praluent (Caremark)
Pred Mild (Express Scripts)
Pregnyl (Express Scripts)
Prolastin-C (Caremark)
Qsymia (Express Scripts)
Recombinate (Express Scripts)
Saizen (both)
Savaysa (Express Scripts)
Sorilux (Caremark)
Sovaldi (Express Scripts)
Synerderm (Caremark)
Targadox (Caremark)
Tirosint (Caremark)
Topicort spray (Express Scripts)
Tradjenta (Caremark)
Uroxatral (Express Scripts)
Vagifem (Express Scripts)
Vanatol LQ (Caremark)
Vanatol S (Caremark)
Veltin (Caremark)
Verdeso foam (Express Scripts)
Viagra (Express Scripts)
Vivelle-Dot (Express Scripts)
Xadago (Express Scripts)
Xerese cream (Express Scripts)
Xyntha (Express Scripts)
Xyntha Solofuse (Express Scripts)
Yasmin (Express Scripts)
Zemaira (Caremark)
Ziana (Caremark)
Zolpimist (Caremark)
Zomacton (Express Scripts)
Zonegran (Express Scripts)
Zuplenz (Caremark)
Zurampic (Express Scripts)
Zypitamag (Express Scripts)

What do formulary changes mean for you?

The list of drugs above generally includes brand-name drugs for which less expensive brand or generic alternatives are available. If your benefits are managed by Express Scripts or Caremark, you will likely have to pay the full retail price for drugs on this list at the pharmacy. You can find the estimated cash price for each drug by clicking on the drug names above.

If you notice that coverage is changing for a drug you take, talk to your doctor to see if a covered alternative might work for you. If you can’t switch, you may be able to use a GoodRx coupon to save up to 80% off the cash price. For qualified patients, manufacturer copay cards and patient assistance programscan also help to reduce the price of expensive medications. Simply look up your drug on GoodRx.com or the GoodRx mobile app and click on “Savings Tips” to find out if these programs are available to you.

An important note about Medicare and private plans:

The new drug exclusions above DO NOT apply to Medicare plans; if your Medicare drug benefit is managed by Express Scripts, check your prescription coverage with your pharmacist or online through the Medicare.gov portal.

Also, some individual private insurance plans managed by Express Scripts or Caremark may have a different list of excluded drugs than the one above. This means that drugs on the list above may or may not be covered by your plan if you have coverage through work, for example. Please get in touch with your insurance provider if you have any questions about your coverage.

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