By Bill Rusteberg
Small group plan maintains an open Rx formulary, a ticking time bomb.
Now we learn of one plan member taking Oxervate, a specialty medication used to treat neurotrophic keratitis. The price for a full 8-week treatment course can range from approximately $60,000 to $118,000, depending on the source.
The patient needs this medication or go blind. Removing coverage for it once it’s in place would be inhumane. Such is the quandary many plan sponsors with open formularies will inevitably face at one time or another.
Limited formularies provide opportunities for members in need of non-covered prescriptions. More and more plans are beginning to understand that.
