There are two reasons that this is happening: Hyperinflation of prices and the availability of “biosimilars” — not identical but similar medications to an expensive drug. Hyperinflation is a term for drugs that have had massive price hikes. When a biosimilar alternative exists, these carriers refuse to cover the hyperinflated drug to force drug companies to lower their prices, which can ultimately save us, the consumer, significantly.
This isn’t the first time popular drugs have been dropped from coverage. Just this year, Qsymia, Abilify, Viagra, and others were dropped coverage. In 2017, several expensive cancer drugs and hepatitis C medications will also be dropped. Adjustments to the list of covered drugs are likely to occur annually.
As a result, it’s important to take the time to make sure you’re ready for the coming changes:
- Review the list of drugs being dropped from each company’s formularies for 2017.
- Consider switching insurance providers if you require a specific prescription that will no longer be covered.
- If you’re blindsided by a drug no longer being covered, it is possible to appeal the coverage decision with your insurance provider. To get your drug covered through the exceptions process, see the requirements here.
- Some insurance companies will provide a one-time refill for your medication after you first enroll. Ask your insurance company if they offer a one-time refill until you can discuss next steps with your doctor.
If you don’t already have one, you can download a free card online today or request a card by calling 1-800-222-2818. You can also get the free FamilyWize app, available for both Android at the Google Play Store and Apple Devices (iPhone and iPad) at the App Store.