Medications That Are Often Excluded From Pharmacy Benefits All health insurance plans have a drug formulary or a list of covered medications. The medications not covered in the formulary are excluded. Most of these excluded medications include the ones that are used for cosmetic purposes, such as supplements for clear skin and hair growth stimulants. Non-traditional drugs like food supplements, alternative medications and experimental drugs are also often excluded from pharmacy benefits. Notably, diabetes drugs have been among the most excluded category, with the number of exclusions increasing year-after-year. Medications excluded from the pharmacy benefits are often the expensive brand name for which low- cost generic alternatives are available. Supportive garments and back braces are also often not covered for the workers whose work demands long hours of standing, such as sales executives and restaurant attendants.
Pharmacy benefit managers decide on medications’ exclusion While you may have health insurance from a particular provider, your pharmacy benefits are often handled by pharmacy benefit managers or PBMs who set formulary for everyone under their prescription drug benefit. Express Scripts and Caremark, the two leading pharmacy benefit managers that handle pharmacy benefits for more than 200 million Americans removed more than 90 medications from their formularies at the end of 2018, and the new drug exclusion list for 2020 will soon be out by the end of 2019. By excluding the medications, PBMs are able to derive prescribing decisions towards the favored therapies. Drug exclusion hinders access to treatment You will have to pay the full price of the medication excluded from the formulary list by the PBMs, even if you have insurance. Formulary drug exclusion also reduces the patient’s access to treatment as they will have to pay full cost for the medication, regardless of their condition, be it chronic or acute. The number of drugs included in the formulary exclusion list has increased significantly in the past few years, and may leave hundreds or thousands of Americans without proper treatment for their illnesses. Some stable patients may lose access to their prescription medications in the middle of their treatment regimens due to drug exclusion, resulting in increased healthcare burden and adverse results for them. You can still save on excluded medications with EzRx drug card If your medication is excluded from the pharmacy benefit, ask your doctor if a covered alternative medication might work for you. If you can’t switch, you can always use EzRx drug card to save on prescription medications. With EzRx drug card, you can adhere to your established regimens with increased affordability of medication. EzRx drug discount card can be used to save anything from 10% to 85% on your various branded and generic medications such as Adipex, Albuterol, Cymbalta, Lisinopril, flu vacation and other medications that you may need to treat your various diseases related to heart, kidneys,