Medco "Preferred Drug List"
Last updated:   01/09/2010      16:44 -0500
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The information below was written by a TCNJFT unit member who is a healthcare professional and full-time faculty member.  Local 2364 assumes no legal responsibility for the views expressed herein. It should be considered one person's opinion on issues related to Medco's "preferred drug list."

While I am also concerned about the new Medco drug plan I want to clarify that what they are doing is not entirely different from practices of Caremark or other prescription drug plans. What is my authority to do give you this information? I am a nurse practitioner as well as on faculty. I practice few hours a week in order to keep my certifications. Over the years I have faced this problem often when I prescribe medications for clients. Each insurance company has a different list of preferred medications causing healthc care providers to need special software that allows us to look up the approved medications for each company.(Ladies, the insurance companies even choose your birth control pills for you as far as coverage of various brands is concerned). 

I also personally ran into this problem with Caremark and have been paying a much higher price for several years for a medication that is medically necessary. Years ago, after having a potentially life-threatening reaction to a generic brand of a medication I must take daily, my health care provider put me back on the brand name drug - and Caremark stopped paying for it. Caremark did not accept my medically necessary petition and I have been paying for the drug myself ever since. Luckily for me this medication is affordable as I am not yet ready to be die from a drug reaction or any other cause!  

So, while we all unhappy about insurance companies making decisions for us, at least Medco is being upfront about it and letting us know in advance. (Please don't think I am excusing their behavior. I am not.) There is also a clause at the end of the drug list that says the prior approval policy is only applicable to new drugs and that the company will supply individuals with drugs that the person was on prior to the transfer to Medco. I'm sure they will charge at the highest rate in that circumstance as these companies are known to do. I hope the prior approval process works for those who truly need drugs that are not on the approved list and that it is carried out in a timely manner.   

As for the substitute drug list - It is a common drug company marketing strategy to create a similar drug to one from another company that is selling well for that company. They change a little bit of the molecular structure and claim it is vastly different and better than their competitors. They get a patent and FDA approval. Beacuse this is a newly patented drug, no one can produce a generic for it so the company has an exclusive right to market this product and at whatever price they want. Hence we have Viagra, Levitra, and Cialis, each of which treats THAT unspeakable problem, with only slight differences and each of which has been a big money maker for their respective drug companies. They each have the same side effects and warnings (Call your doctor if you experiences changes in vision, chest pain, etc.......). 

 Once a new drug is patented and approved, the manufacturer then blankets doctor's offices with samples to give their patients (we as patients love freebies) and lots of literature claiming the superiority of these drugs over the older, and now cheaper drugs (because there are often generics for these drugs). The insurance companies will contract for certain drugs within a class and offer the ones they can get most reasonably. Remember both insurance and drug companies are in the market to make money.  

For example, Benicar is a newer drug in a class called ARBs (Angiotensin II REceptor Blockers) which have been around for years. The preferred drugs listed for Benicar are in the same class of drugs and are similar in pharmacological action. There is a good chance that one of these other drugs will work just as well. I hope this is the case for our fellow faculty member.  If the person has been on the Benicar before our transfer to Medco, they should call medco and make sure that Medco is aware that this is not a "new" prescription but a renewal of an established treatment. Hopefully Medco will stand by the statement on the drug list - which I think I am interpreting correctly.  

I hope our union can be effective in their efforts to get this policy repealed, however my guess is that will not happen since this is not an unusual insurance company policy.  Personally, I think the most discouraging thing is that the insurance company and drug company lobbies in Washington have succeeded in buying off enough of our legislators Think Lieberman!) so that if we get "health reform" at all, it is not going to be true reform. We will be fighting these battles for the rest of our lives and people will still be dying because they cannot get the care they need.