I feel fairly silly asking this question but I’m confused. We just got a letter from Express Scripts saying they are dropping some medications that I purchase. Sometimes I get the prescriptions and send in to Express Scripts to fill and sometimes I have it filled at CVS.
At first I thought it meant that my insurance (Anthem) would no longer pay for me to purchase at the discounted rate at all. But maybe it means that only Express Scripts won’t fill my 90 day script any longer. If I fill it at CVS or another pharmacy, will it still be paid at the lower rate. Or does Anthem have nothing to do with my prescriptions?
I’m totally confused…and ticked off.
Edited to say: Disregard. Found out answer and I’m mad.
What’s the answer?
I had this happen with a mail order drug. Express Scripts just stopped carrying it. I was, however, able to get it refilled at my local pharmacy no problem. BUT my insurance gives me three months for the price of two with mail order…so I lost out on that discount. Also, I couldn’t get a three month supply at the pharmacy.
The letter said something like “Your Company, Inc. And Express Scripts, who administers the pharmacy will no longer be providing xxx”. So, Express Scripts is separate from my insurance. I think it’s just terrible. These meds are for my boys and I don’t want them on a generic or playing around at this point finding something that works. They’ve been on these for years…ADHD meds, and they are working fine.
Yes, Express Scrips is separate from your medical insurance.
Are you saying that these RX will no longer be covered at all? Or are you saying that ESs is asking you to use a generic? Or what?
You should be able to appeal if this is a drug that has been used for years.
Walmart pharmacy has a very extensive list of prescriptions for $4 a month picked up at your local store or $10 for a 3-month supply mailed to you with free shipping. I found that it was much cheaper than the insurance copay at the pharmacy. Worth seeing if your meds on are the list.
I fill my prescription online using the 3-month option. Takes about four days for it to arrive. Or you can do online refill for store pickup and they email you when its ready.
@interesteddad
The trouble is…some drugs are not in the $4/$10 list…and also are not carried by Express Scripts.
I now pay a $10 per month copay…so $30 for three months…when mail order was $20 for three months.
And one of my prescriptions was moved from name brand preferred with a monthly copay of $35 to non-preferred at $50 a month…and nit available through mail order. And no generic available at all.
It’s a headache when this happens…especially when it’s a maintenance drug that you need every month…and have taken for years.
Express Scripts is a PBM, or pharmacy benefit manager. They contract out with your managed care provider to handle the pharmacy side of things. When Express Scripts decides there are equivalent drugs, they may decide to stop using one and use the other exclusively. That’s where their huge buying power gets the best bang for the buck. The PBMs have been making headlines lately over the multi-thousand dollar hepatitis treatments that they are pitting against each other for exclusivity. It happens on many drugs and is their way of cutting costs to users. It’s been a great stock too! 
You may be able to get an override if the doctor is willing to assert the medical necessity for the specific med.
I agree with CountingDown. A number of years ago, my insurance company (Anthem) refused to pay for a certain drug that was prescribed for my kid to help control his Tourettes. It is actually an epilepsy drug, low dosage, that had been prescribed by his neurologist, who was an experimental sort of guy, top in his field. The insurance company declared that this drug was not appropriate for Tourettes. Apparently they thought it was better to prescribe a far more invasive drug, as opposed to a small dosage of something less invasive. A letter from the physician, and no more problems. They kept paying and never stopped.
We just had to do this with one of my kid’s prescriptions. And you can betcha that if the pharma benefits company ever messes with my chemo (one of my previous meds is about to go generic), the onc and I will be raising holy hell.
I did give the letters to their doctors office and asked if they would call. That was just a couple days ago, I need to check back. One son is on Vyvanse and there is no generic. I asked CVS how much it would be full price and its 258 per month. With a coupon, I can get it for 198, 40 more than I’m paying now…not terrible if I have to do that… Other med is Focalin and without insurance it’s 360 per month…much more. There is a generic and they don’t carry that either! However the generic version is 162 without prescription, similar to what I’m paying now. Sucks. They are not guinea pigs.
I would definitely complain. If you have to go with the coupon for Vyvanse when it “runs” out you can register for a new one. I didn’t realize that and ended up spending extra money for a couple months until I mentioned to the pharmacy that I wished I still had the coupon and she told me that I could register for a new one…
Here’s an interesting way you might be able to solve the problem. My H’s doctor prescribed a new medication that wasn’t covered by Express Script Medicare. I contacted the pharmaceutical company and they were all over it. Sent one month free, worked with physician and then pounded the insurance co until it was completely covered in their formulary for the disease. All fixed in 4 weeks!