“Physicians will have more choice, fewer patients will be disrupted from their existing therapies, and our clients will realize significant savings.”
Thoughts?
This set my cynicism alarm ringing nonstop. I will let others comment. (Hint: “medication adherence levels”.)
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I may have read through the link too quickly and missed any mention of a “preferred formulary”. If this was left out, I suspect it wasn’t an accidental oversight. Speaking for myself, both as a physician and a patient, I don’t trust health insurers any more than I trust starving crocodiles.
I believe everyone and their dogs will be well-served if they assume the words “value program” means “program designed to severely limit the choices of PWDs in order to insure our CEO and stockholders are happier and richer.” Add to that “another program to hamstring physicians in their efforts to care for their patients.”
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This was the only mention of the formulary:
“In conjunction with the announcement of the Diabetes Care Value Program, Express Scripts is also announcing that its 2017 National Preferred Formulary will include multiple preferred basal insulins. Pending market entry later this year for the country’s first follow-on insulin, Basaglar® (insulin glargine), Express Scripts plans to add Basaglar as a preferred product for the National Preferred Formulary, alongside the originator product Lantus® (insulin glargine.”
Jeez, how many different versions of Lantus are there going to be??
I think we may need a massive whiteboard to keep track of which PBM allows which insulin. The 2017 formulary should be interesting.
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It might be prudent to do a little reading between-the-lines to add “will include multiple preferred basal insulins (but very possibly not the one you find most effective)” along with “plans to add Basaglar while simultaneously removing from the formulary all but the least expensive rapid-acting insulin (whether it works for you or not.)”
But fear not, if your preferred insulin is removed from their “value program”, it will only take a very time-consuming prior authorization (which may be denied a time or two for the sheer drama) plus a much higher-tiered copay to get what you need to keep living. 
Just how gullible do they think we are?!?
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As long as we accept the model of insurers paying for medications instead of patients we hand over both the control of selections and the natural mechanisms to control prices. The insurance model itself is the cause of the vast majority of runaway healthcare costs in this county.
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@Sam19, providers (mainly hospitals & clinics) can certainly share in the blame. Most businesses would love to be able to get away with the markups enjoyed by the US healthcare industry.
Remember, never smile at a crocodile.
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Please disinclude private practice physicians from your list of providers. Every physician I know is doing everything within their power to get their patients the meds they need. We see zero profit (or benefit to ourselves or our patients) when medication prices are marked up.
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So true. The only insulins listed as Tier 1 in my insurer’s formulary are Humalin 70/30, Humalin N, and Humalin R.
Lol… That’s stellar when your prescription drug plan only prefers non-prescription drugs
The only saving grace is that they’ve never tried to make me use them. All the modern insulins (except Afrezza) are Tier 2. Sadly, Afrezza is not covered.
I was referring to Sam19’s statement that
“The insurance model itself is the cause of the vast majority of runaway healthcare costs in this county.”
Every part of the medical machine shares the blame for runaway costs.
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Along with government and a few other entities not named.
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I looked into this in more detail. Here is the 2016 Express Scripts Exclusion list and here is the 2017 list. Really not much of a change, they made Humalog the prefered modern analogue insulin (and excluded Apridra and Novolog as in 2016). And all they say is that the biosimilar Basaglar will be added, probably moving Lantus to non-preferred status. And if you look at the Express Scripts 2016 Preferred Formulary you will see that while Express Scripts has made a preferred choice in rapid modern analogue insulins, all the basal choices are allowed. Here is the 2016 preferred insulin list:
HUMALOG [INJ]
HUMULIN [INJ]
LANTUS [INJ]
LEVEMIR [INJ]
TOUJEO SOLOSTAR [INJ]
TRESIBA [INJ]