I felt that I should let people know what I found out this month when I went to order my mail order scripts. My insurance uses Express Scripts, who I also know administers many health coverages nationwide. The new formulary list for 1/1/06 was there so I downloaded and read it. Lipitor is coming off the formulary, but some of the other brands will still be on. My doc tells me the others are not close enough in formula to give the same effect, so I really don't understand why Express Scripts would remove it. Lovastatin, Crestor, Vytorin, Zocor will be allowed.

You might want to check your coverage. This formulary affects both local drug stores as well as mail order. :eek: :eek:

Thanks for the tip Momcat1,
I have Express scripts thru my insurance, too. I don't use lipitor, but will check the list for the other drugs I use.
Don't know why they always change these things on us. IT's affected my BP meds in the past. Guess name brands are too pricey for them to keep covering.
Thanks again for the info.

Sure thing, glad to be of help. I don't know if the BCBS formulary that I use is the same for all the other plans, but I do know that government programs also use Express Scripts. I'm trying to find another way to get the word out, cause this is just plain silly!

On a related note, my BP med is also coming off, Avapro, and replaced with Cozaar and Diovan. When I checked the cash prices, Avarpo is markedly less expensive than the others, which makes no sense. But my doc said the other two in that case were relatively interchangeable. I sure hope so cause when he started me on Avapro, I remember going through 4 others and finding out my body could not tolerate them.

I really can't afford to have to pay cash for the meds. That's why I'm paying premiums to have medical coverage, just like a lot of people. Did Express Scripts even think before making these changes? I doubt it.

Sure thing, glad to be of help. I don't know if the BCBS formulary that I use is the same for all the other plans, but I do know that government programs also use Express Scripts. I'm trying to find another way to get the word out, cause this is just plain silly!

On a related note, my BP med is also coming off, Avapro, and replaced with Cozaar and Diovan. When I checked the cash prices, Avarpo is markedly less expensive than the others, which makes no sense. But my doc said the other two in that case were relatively interchangeable. I sure hope so cause when he started me on Avapro, I remember going through 4 others and finding out my body could not tolerate them.

I really can't afford to have to pay cash for the meds. That's why I'm paying premiums to have medical coverage, just like a lot of people. Did Express Scripts even think before making these changes? I doubt it.

Well I have BC/BS and I have been on Avapro for the past 9 months, so they had best be covered, as they are darn expensive. My husband goes to the VA so his meds come in the mail, I will definitely have to check to see if they use Express Scripts. Geez, can they screw the public anymore then they already do?.................. :eek: :mad:

Thanx for the heads up, I am definitely going to a see if we will be affected.

My HMO also offers the use of Express Scripts for mail order of 90-day supplies of maintenance meds such as statins. However, I am under the impression that it is the HMO or insurance carrier that dictates the formulary, not Express Scripts, whose job it is to administer whatever the ins. co specifies.
Am I wrong here?

Tobias, You might want to check your coverage. Express Scripts usually does administer both the mail order and brick and mortar.

Everyone, I did some more searching online last night and found out why Express Scripts did this. Apparently one of the substitutes comes off patent in the middle of 2006, so they decided to push people into using that instead, which would cut Express Scripts costs. Pfier turned around and cut their rebates to Express Scripts, because of the action. Considering that the article stated Express Scripts covers 50 million people in the US, I'd say there's going to be a whole lot of turmoil come January. And I don't see that there's anything that we can do about it. It's not like most of us can just wake up one morning, and find another carrier.

Express Scripts works with its plan sponsors in a consultative capacity to design a prescription-drug benefit
program that meets the plan sponsor’s needs. The Express Scripts plan sponsor makes all decisionsrelating to:
• The coverage of the drug plan
• The formulary
• Plan-design features, such as copay structures, stop-loss amounts, benefit caps, zero dollar copays for
generics, High Performance Formulary, Closed formulary benefits etc.
• Utilization management offerings, such as step therapy, prior authorization, quantity level limits and
physician consultation
Express Scripts will recommend one of its formularies to a plan sponsor; however, the plan sponsor may
require that the formulary be changed in certain respects. Express Scripts’ managed-care plan sponsors, in
particular, often require custom formulary-management options. In every case, however, the plan sponsor
actually selects the formulary. Similarly, Express Scripts recommends plan designs to assist clients in
achieving their pharmacy benefit objectives (e.g., cost management, generous benefit) goals, but in every
case, the plan sponsor makes the decision on what plan it will offer.

Tobias, I agree with your observations. However, in real practice, it is nearly impossible to have such a change enacted (I do have prior experience in this area). I wish you luck if you plan to pursue it.