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In the latest bid to control prescription drug spending, the nation’s largest pharmacy benefits managers are again excluding dozens of medicines from their lists of products that are covered by health insurance, which are known as formularies. PBMs, you may recall, are crucial, behind-the-scenes middleman who negotiate drug prices on behalf of companies, unions, and government agencies.

On Monday, Express Scripts notified its customers that next year, 85 medicines will be excluded from its national formulary, and, as a result, the PBM hopes to recognize about $1.8 billion in savings, up from $1.3 billion this year. The number of excluded medicines, by the way, is down slightly from the 88 prescription drugs that were excluded from its 2016 formulary.


This morning, CVS Health released its own 2017 formulary that will exclude another 35 medicines, including 10 that were called “hyperinflationary.” As a result, CVS is now excluding a total of 131 medicines and boasts such moves have saved more than $9 billion over the last five years, according to a CVS spokeswoman. The PBM did not provide a specific savings estimate, but Barclays analysts forecast about $2.6 billion should be saved next year.

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  • I’m a certified diabetes educator and pediatric nurse practitioner. It infuriates me that insulins such as Novolog and Levemir are so expensive. People are being forced to use the insulins that were the only insulins available 20-25years ago because they are cheaper. Cheaper is not better – the older regular and NPH insulins provide less predictable responses than the newer more modern insulins. Life sustaining medications need to be affordable to all. Long term complications from diabetes are related to overall blood glucose control — diabetes is hard enough. People shouldn’t have to choose between paying for insulin or paying their utilities. Lilly, Novo Nordisk or Sanofi Aventis need to cut their prices. Just today I was quoted a cash price of Humalog kwikpen 1 box of 5 pens to be $115 while an equivalent amount of Novolog would be $618.00. This is crazy!

  • I have had to change from Novalog and Levmir to over counter Region Jumping R and N they are $24 a bottle at Wal-Mart .We have insurance it’s better for us to use CVS to fill scripts they want $250 per insulins in co-pays.I can’t do that I work two jobs just to keep up my health which in turn has caused more trouble.I am glad to see the FDA change and say the CGM can replace regular glucose machines.I have one of these that is super helpful with my care.I haven’t been able to use this could not afford the sensor for machine

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