This could have a major impact. CVS excluding Lantus as well as other that impact those with diabetes.
http://apps.npr.org/documents/document.html?id=3011316-2017-Formulary-Drug-Removals
Someone want to start a thread?
I see cvs is dropping lantus and toujeo. They do cover tresiba and novolog though. I personally don’t have a problem with this.
The noteworthy news I see here is that they seem to both be covering tresiba as it appears now. I’m not sure if express scripts was in the past… Although EXP specifically states that their basal insulin category may be updated in future.
As I consider tresiba the basal of the future, hands down bar none-- I consider this a win for people with diabetes in the long acting insulin category. I don’t know enough about the various other meds to have an opinion…
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Why should a PBM make broad medical decisions about what treatments do and don’t work for patients? Nobody has done any sort of study of what the impact is in not having access to these treatments. Despite claims, insulins are not all the same and drugs are not all the same. They are just not interchangeable and it should be up to the patients doctor to make the medical decision about what is appropriate. This is exactly the root of the problem with the UHC pump decision.
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The first article listed makes the point that formulary exclusions were invented, and are used, to give PBMs leverage with manufacturers. If the manufacturer doesn’t cooperate on price, the PBM threatens to exclude their product altogether.
That’s the theory. Of course it doesn’t help, because (a) prices keep climbing anyway, and (b) once a product is excluded the price becomes prohibitive overnight.
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Brian, I am fascinated by these lists, thanks for sharing. I was amazed by the amp up of the rhetoric in the CVS Caremark report basically warning manufacturers that they should not unduly raise prices, lest they lose their approved status. It is amazing.
How ARE decisions about formularies made? Do the insurance companies analyze patient prescription data? Follow client policies? Some other basis? In my plan, Toujeo is covered under special circumstances only (ditto Afrezza) while Tresiba (and Apidra) are covered but at a higher co-pay. How do insurance fompanies arrive at a structure like that? Anybody?
I’ve said it a bazillion times, but I’ll say it once more: Effing health insurers!!!
It is so very wrong that they dictate, to an ever increasing extent, how medicine is practiced in the U.S.
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IMO, formulary decisions are based solely on one factor: the almighty dollar.
You’re probably right but…surely there must be an actual rationale?? I have a social science research background, that’s why I’m hopeful?? 
There was a day when formulary decisions were made by a medical committee that reviewed the literature and determined whether a treatment was effective and safe. For many new medications that is still the case and insurance companies make a decision to include a medication a year or two after a new medication comes out as they “gather the evidence.” But increasingly these decisions seemed based on economic considerations, not medical evidence. What evidence is there that Lantus is inferior or unsafe?
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This is still the case in BC: the government makes decisions based on a combination of the literature and what people are actually being prescribed. But one problem with this is that I see so many in the US complain about things not being available/covered immediately, and this would certainly slow things down even more (no one would be covering Afrezza, for example), which people would probably hate. It’s also not always that great, because research doesn’t always show what those of us with diabetes would wish. The reason CGMs are not covered yet is, in part, that research is just emerging saying that they are a tool that can improve health (hopefully it’ll be covered in the future). And test strip limits have been imposed because, in part, because research shows that testing more often has no benefits (especially for those with Type 2). So, pros and cons to both ways of doing things, in my opinion.
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I was looking at the Express Scripts listing and saw that many, many types of BG meters and strips (including FreeStyle, the one I use) will be non-formulary in favor of 1 provider only!! How can a single provider possibly keep up with demand? And how can that be cost-effective? 
I’d say it’s pretty cost-effective for the health insurers using Express Scripts as their pharmacy… 
Bruce…There is evidence, (google it), that Lantus attaches itself to cancer cells that are not killed off by the Immune system and causes those cells to proliferate, (grow and replicate), I am on a pump now and will only use Lantus as my back-up if I can’t get Levemir.
So, are these lists of possible exclusions? or are they definite exclusions? And, since I use Lantus and CVS is my prescription plan/insurer/whatever, does that mean I can no longer get Lantus without paying full price out of pocket or does it mean the co-pay will be much higher? Maybe these questions can’t be answered but I thought I’d toss them out there.
Arrgh!
It means they’d ask you to switch to basaglar (generic lantus) or one of their brand name formulary alternatives like tresiba or levemir