If you’ve been reading this blog for a while, you’ve probably already heard us preach the importance of checking your plan every year any changes your health insurer may make to it. Most people find that’s pretty easy for things like health insurance premiums, deductibles, co-pays and co-insurance, but if they forget to check anything, it’s usually their prescription drug formulary, which unfortunately, is oh-so-important to many people.
A prescription drug formulary are the lists of prescription drugs covered by a particular drug benefit plan, and also include the copayments required in connection with a particular prescription drug. If you have a chronic condition such as high blood pressure (hypertension), high cholesterol or diabetes, whether the prescription drugs that you take regularly are on your health insurer’s prescription drug formulary and wherethey are on your formulary can make a huge difference in how you and your doctor manage your condition and how much your condition can be costing you on a monthly basis.
This was never as clear as when we were reading David Lazarus’ recent column in The Los Angeles Times on recent moves of fast-acting insulins NovoLog and HumaLog on its prescription drug formularies. You see, NovoLog used to be on Tier 1 of UnitedHealthcare’s prescription drug formulary, and UnitedHealthcare has now moved it to Tier 3. Coincidentally, HumaLog has been moved from Tier 3 to Tier 1.
Mr. Lazarus and his doctor have been successfully managing his Type I diabetes with NovoLog for years, so how does this affect him?
UnitedHealthcare is telling NovoLog users that they can avoid a price hike by switching to another insulin, Humalog, which will move from the pricier Tier 3 to Tier 1. But Peters said this isn’t always a good idea.
NovoLog and Humalog are similar, but they’re not identical. “There are many people who do well with one but not the other,” Peters said. “As a doctor, I would tell patients that if you’re doing OK with a drug, you shouldn’t change it.”
UnitedHealthcare is thus putting many diabetics in the position of having to choose between paying a significantly higher price for the medication favored by their doctor or accepting the cheaper (and potentially less-effective) alternative preferred by the insurer.
For me, this issue isn’t just academic. UnitedHealthcare is my employer-provided insurer, and I have Type 1 diabetes. I’ve been on NovoLog — at my doctor’s recommendation — since my disease was diagnosed three years ago.
As a Tier 1 drug, NovoLog costs me a $20 co-pay when I buy a one-month supply that would otherwise cost about $113.
When NovoLog moves Jan. 1 to Tier 3, my monthly copay will rise to $70, increasing my annual out-of-pocket expense for insulin 250% to $840. That’s on top of the thousands of dollars I have to pay each year for blood-sugar testing supplies, insulin-pump gear and doctor visits.
As you can see, changes in your prescription drug formulary can result in huge changes in how you life your life. Don’t ignore it! If you’re in the middle of Open Enrollment, you can try to change to a health insurance plan with a much better formulary for you. Shop around!
Have you looked over the changes to your prescription drug formulary lately? Tell us about it!
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