Consumers Caught in the Middle
Bottom line first: Drug companies are in business to make money. Insurance companies strive to keep drug prices low—to increase their own profits. That leaves health care consumers right in the crosshairs.
Adding to the problem, insurers can remove drugs from their “approved medications” list if manufacturers don’t agree to reduce prices, and that can force patients, and their doctors, to scramble to find alternative medicines that are effective and safe. Large prescription insurers like CVS Caremark and Express Scripts recently released their lists of approved drugs for 2017, and each one contained a number of excluded medications. CVS excludes about 130 drugs and Express Scripts, which does not ban cancer drugs or mental health medications, lists about 85.
By excluding certain medications from coverage, insurers help keep drug prices down for consumers. In most cases, there is a cheaper, equally effective—perhaps generic—drug available, which will be covered. Patients also can appeal to have their medication covered, but it’s a difficult process. Check with your doctor, pharmacist, or insurer before heading to the pharmacy to refill your prescriptions to avoid any surprises when the new exclusion lists go into effect.
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