Drug Formulary Exclusion Lists Reduce Patient Access to Treatment

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Drug formulary exclusion lists have grown by 160 percent since 2014, hindering patient access to treatment.

By Sara Heath

January 04, 2018 – Drug formulary exclusion lists are getting longer, making it more difficult for patients to access the medications and treatments they may need to manage their illnesses, according to a recent study from the Doctor-Patient Rights Partnership (DPRP).

A drug formulary list is “a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits,” according to Healthcare.gov.

A formulary exclusion list includes the drugs that an insurer, health plan, or pharmacy benefits manager (PBM) does not cover.

Proponents of drug formulary exclusion lists say they quell costs by having patients use lower cost drugs. Ideally, patients should be using drugs that are the best value for their cost. CVS estimates that it will save over $4 billion from its exclusion list in 2018, and Express Scripts reports it will save about $2.5 billion.

However, drug formulary exclusion lists are growing too long, which keeps patients from accessing the medication they truly need. Drug formulary exclusion lists ranked as the top reason why a patient’s medication claim was denied in 2017, with 37 percent of patients reporting such, according to the DPRP report. Read more.

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