Skip to main content

Major Changes to Express Scripts Formulary Will Affect Many Asthma and Allergy Patients

I just received notice that as of January 1, 2014, the Express Scripts formulary will be removing a number of medications from its repertoire of covered drugs. This means that patients under the Express Scripts plan will have NO COVERAGE for these prescriptions, and will be required to pay full price at the pharmacy. The list is long, and heavy on medications commonly used by patients with asthma and allergies:

Asthma medications:

Advair diskus
Advair HFA
Alvesco HFA
Flovent Diskus
Flovent HFA
Maxair Autohaler
Proventil HFA
Xopenex HFA

Allergy medications:

Auvi-Q
Beconase AQ
Omnaris
Rhinocort Aqua
Veramyst
Zetonna

As insurers continue to seek ways to cut costs and boost the bottom line, they will negotiate with pharmaceutical companies to obtain lower pricing. Those companies that play ball get to keep their drugs on the formulary. Those that don't, get dropped. The losers are the patients who will be required to switch from medications they have been taking successfully.

If you or a loved one are taking any of the medications on the above list, I would encourage you to schedule an appointment with your Board-Certified Allergist to discuss a trial of a covered alternative medication well in advance of January 1st. Your physician may have a sample of the new medicine that you can "try before you buy". You don't want to be in the position of being forced to switch before you've determined which alternative works for you. You may also want to take advantage of 90 day supplies of medication before the year ends and your coverage expires. Some of the soon to be excluded medications currently have manufacturer's coupons that will be valid through the end of the year.

Talk to your doctor -- we're here to help you navigate through the complex state of medical affairs.

Comments

  1. Hello Dr. Bajowala,

    Thank you for the wonderful post that explains the complexities of pharma pricing so clearly. I wanted to get in touch regarding a new educational asthma mobile game that might be of interest to you. I sent you a LinkedIn message but wanted to follow up in case you hadn't seen it. I hope to hear from you soon!

    All the best,
    Alex Ryu

    ReplyDelete
  2. The politics of pharmaceutical companies sort of baffles me, to be honest. I suppose that's to be expected since I am on the ground level and they are thinking about millions of people at any given moment. But here is the problem with that disconnect! If they were taking those medications as well then there is no way they would pull that funding. I don't know whom is responsible.

    Nassim O'Shaughnessy | http://regionalallergycenter.com/

    ReplyDelete

Post a Comment

Thanks for taking the time to comment on this blog's posts! Let's keep the discussion engaging and free of frivolous advertising or vulgarity. It's a family show, folks!

Popular posts from this blog

Keratosis Pilaris - Or, Why My Kid Looks Like a Plucked Chicken

The skin is the body's largest organ. The condition of the skin is, in many ways, a window into our internal health. Therefore, it is only natural that people become immediately concerned by rashes. We often neglect our own elevated blood pressure, achey joints, or other ailments. The onset of a new rash, on the other hand, can quickly lead to a call to the doctor.

Interestingly, there is one rash I see in my practice which rarely causes alarm among patients and parents. In fact, it is common for a parent to state, "Oh, that? His sister has that too. In fact, so do I!"

Keratosis Pilaris is a common, heritable disorder which results in small bumps consisting of accumulated skin cells and keratin at the sites of hair follicles. It is especially common in people who have a history of allergies.
Although it can be mildly itchy, the rash generally does not cause discomfort. Commonly described as "gooseflesh", keratosis pilaris can be a concern cosmetically, leading…

When Food Allergy Treatments are Sensationalized, it is the Allergist's Role to Bring Us All Back Down to Earth

Sharing a recent post from my practice Facebook page, in response to concerns raised by the recent publication of a meta analysis on anaphylaxis rates during food allergen oral immunotherapy: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30420-9/fulltext
I hope my comments are helpful at proving some context for patients currently pursuing or consider food allergen desensitization therapy. 
I am a non-alarmist by nature, and feel it is 100% possible to integrate new data without falling prey to the sensationalization of these publications by the media. It is frustrating to read in the news one day, "Researchers find CURE for peanut allergies!" (WRONG!!!) and the next day read "Experimental treatment for food allergy causes more life-threatening reactions than avoidance!" (Hmmm...a bit misleading). No nuance, no thoughtfulness, no concern for the impact of such a black & white approach to a decidedly grey issue. And why would there be? Nuance …

Why Drug Allergies Matter (Or Why Penicillin Allergy is Responsible for My Son's Lopsided Neck)

My 6 year son old just got over a rite of passage - strep throat and scarlet fever. Unfortunately, before we could even celebrate his recovery, I noticed a swelling on the left side of his neck. It was red and tender, and it was GROWING. The pediatrician in me worried, "Damn. Lymphadenitis (infected lymph node)". No sooner had we finished one course of antibiotics than we were onto another, and the side effects were bad enough to keep him out of school for another three days.

Why did my munchkin suffer so? My answer: Drug allergy.

Group A streptococcal bacteria (the cause of strep throat and scarlet fever) is remarkably sensitive to penicillin. Penicillin is the first choice treatment for strep throat, and has been proven to reduce the risk of developing rheumatic fever, a post-infectious complication which can result in chronic heart disease.

Problem is, my son is allergic to antibiotics in the penicillin family. At 11 months of age (8 days into his second ever course of am…