Tier 5 Drugs on Formulary

[somarco]

What are the odds of tier 5 drugs disappearing from formularies next year?

What other tricks can PBM's use to limit coverage on expensive med's?

 

[kgmom219]

What are the odds of tier 5 drugs disappearing from formularies next year?

What other tricks can PBM's use to limit coverage on expensive med's?

They can’t do that. If the class is covered, they are required to cover the drug

 

[somarco]

They can’t do that. If the class is covered, they are required to cover the drug

Please explain.

If memory serves me, a few years ago Trelegy was only on a handful of plans . . . the few that had it were higher premium plans.

Are you saying if FDA approves a drug and CMS authorizes it, ALL plans must include the drug in their formulary?

 

[straightnochaser]

PDP's have to cover at least one drug in a therapeutic category so this won't happen

 

[kgmom219]

Please explain.

If memory serves me, a few years ago Trelegy was only on a handful of plans . . . the few that had it were higher premium plans.

Are you saying if FDA approves a drug and CMS authorizes it, ALL plans must include the drug in their formulary?

If Trelegy wasn't there, then Breo was listed.

Its one of the very few things they got right in 2004.

 

[goillini52]

Please explain.

If memory serves me, a few years ago Trelegy was only on a handful of plans . . . the few that had it were higher premium plans.

Are you saying if FDA approves a drug and CMS authorizes it, ALL plans must include the drug in their formulary?

I've had Trelegy covered by 2 different SS plans and Wellcare. The last 2 were the expensive plans.

 

[somarco]

If Trelegy wasn't there, then Breo was listed.

Its one of the very few things they got right in 2004.

I wasn't here in 2004 . . .

 

[Fisher]

I wasn't here in 2004 . . .

Neither were drug plans.

 

[kgmom219]

I wasn't here in 2004 . . .

You missed all the fun with Merck writing the Part D legislation.