![]() ![]() How do health plans determine which drugs to include in their formulary and why do changes occur?Ī health plan may want you to use a different medication in the same therapeutic class because one drug may have a better side effect profile or be more effective than the other. You may have heard the terms non-formulary medications, excluded drugs, or formulary exclusion list - they are interchangeable and mean that certain medicines are not covered by a pharmacy benefit manager (PBM), health plan, or insurance company because such medications are deemed not “medically necessary.” Your health plan encourages you, the member, to use the “formulary drugs” or the “covered preferred alternatives” (drugs in the same therapeutic class with a very similar mechanism of action in treating certain medical conditions). What does it mean when a health plan excludes a medication from its formulary? This decision relieves concern of potential adverse effects on patients’ overall health and wellness caused by this formulary change. In addition to helping alleviate the financial burden, CVS re-adding Eliquis to its formulary is excellent news for patients and their families. Although Xarelto and Eliquis are both blood thinners in the same drug class, each has unique features - please read below to learn more about these two popular anticoagulants. Following the removal of Eliquis from its formulary in January of this year, patients on Eliquis had two options - pay for Eliquis out-of-pocket or switch to Xarelto, another blood thinner in the same class. Effective July 1st, 2022, CVS Health added Eliquis back on its national formulary. ![]()
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