200 Medications Dropped by Insurance for 2021
For the first time in 3 years, fewer drugs are set to fall off the list of medications covered by insurance than the year before. It’s important to find out if the ones you need are among the nearly 200 drugs no longer covered.
That’s because if you take medication, your insurance plan’s formulary — the list of covered medications — can play a big role in how much you pay out of pocket.
If a drug you take is on the formulary, you could see big savings because your insurance helps pay for your medication. If it’s not on the formulary, or has been removed, you’ll have to pay for it yourself. It can be stressful looking for another way to afford your medication, but you do have some options if that’s the case. For example, you can search for a medication discount or ask your provider for an alternative prescription. We’ve offered some tips below.
How often do formularies change?
Just because your formulary covers your medication this year doesn’t mean it will next year. Insurance plans often change their list of covered medications every year. Medications also can come and go from drug plan formularies on an individual basis throughout the year for a variety of reasons. Plan enrollees receive written notice from their insurer informing them in advance if such a change occurs.
Insurance companies work with pharmacy benefit managers (PBMs) to update their formularies. You can find out which PBM runs your pharmacy benefits by asking your health insurance administrator.
CVS Caremark and Express Scripts formulary changes
The two largest PBMs, CVS Caremark and Express Scripts, manage pharmacy benefits for more than 200 million Americans. At the start of 2020, the two companies removed more than 300 medications from their formularies, and they’re dropping nearly 200 medications from their formularies for 2021. That could mean that your medication is no longer covered by your insurance.
If your medication is on the following list of exclusions and your pharmacy benefits are managed by CVS Caremark or Express Scripts, you may have to pay the full retail price at the pharmacy in 2021. However, it’s open enrollment season so you may still have time to shop for a health plan with drug coverage that better meets your needs. Contact your insurance provider with questions.
The medications no longer covered in 2021
Here are the medications that one or both PBMs removed from their formularies and their Canadian prices offered by ADV-Care:
The medications being added back in 2021
In a spot of good news, here is a list of drugs the PBMs are adding back to their formularies after dropping them from coverage last year, also effective January 1, 2021:
- Endometrin
- Euflexxa
- Norditropin
- OneTouch Ultra
- OneTouch Verio
- Spiriva Handihaler
- Spiriva Respimat
- Stiolto Respimat
- Symtuza
- Toujeo
- Zioptan
What do I do if my medication was removed?
First, make sure that the medication you need really was dropped from coverage. There are some exceptions, such as the Medicare program. If you are insured through Medicare, these formulary medication removals do not apply to you. Check the Medicare.gov portal for more information on prescription coverage.
Some individual insurance plans managed by Express Scripts or CVS Caremark may have a different list of excluded drugs than the one above. Drugs on the exclusion list here may be covered by your plan if you have job-based coverage, for example. Talk to your insurance provider or human resources manager if you have questions about your coverage.
How can I save money if my medication was dropped?
Remember that even if your formulary changes and your drug is no longer covered, there are still ways to save money. Below is a quick look at your options.
- Look for drug coverage that meets your changing needs during open enrollment or a special enrollment period if you have a qualifying life event.
- Ask your insurer for an exception. This may involve working with your healthcare provider to submit an appeal.
- Talk to your doctor about switching to a different medication that is covered by your insurance.
- Apply for a patient assistance program or manufacturer copay card.
- Buy Canadian medications from ADV-Care at large savings.
Curtseyed of Kristen Gerencher, MSOT
