Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child. We don’t personally use Express Scripts, but many people have mentioned the following predicament to me…
Express Scripts recently announced that it has taken 48 drugs off it’s formulary for 2014. Among them are several very popular diabetes drugs and supplies including:
- Abbott (Freestyle, Precision)
- Bayer (Breeze, Contour)
- Roche (Accu-Chek)
There are more, but these are probably the most used among people I know. (Here is a PDF of the Express Scripts Exclusions.)
Basically, the company is saying that to avoid paying full price beginning January 1, 2014 for any of the excluded medications, you should have your doctor write a prescription for one of their preferred “covered alternatives.”
Okay. Panic a little. But then get busy if you want to try to fix the situation for yourself.
Here are a few things to try. I’m not guaranteeing these actions will see results, but it’s better than sitting there doing nothing and hoping the problem will go away.
1. Switch brands. That was easy.
2. If your insulin pump uses a particular brand of test strip or if a particular insulin has worked well for you, have your endocrinologist write a letter of medical necessity stating why it’s best for you to continue using the same test strips or insulin.
3. Similarly, if one kind of test strips or insulin doesn’t work well for you at all, have your endocrinologist write a letter of medical necessity stating why.
4. Ask for an override.
5. Look on the company websites for patient assistance programs or copay/coupon cards. We use the FreeStyle Promise Program card and save $50 each time we use it.
6. See if there is another way to get prescriptions covered. Do they have a mail order pharmacy? Do they cover a local pharmacy? Can you get any supplies under your durable medical coverage?
7. Write to the pharma companies and tell them that while you love using their product, they need to work with Express Scripts to get back on the covered medications list.
You may be asking why Express Scripts made this decision. There are several reasons (read this Pharmalot interview) but in the grand scheme of things, none of them matter to us when we want to keep using what has been working well in our own diabetes management.