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Old 08-11-2015, 06:05 PM
 
Location: Tennessee/Michigan
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List of excluded drugs has ballooned from 34 in 2012 to 124 in 2016

CVS drops Viagra, other drugs from insurance coverage | Money - Home
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Old 08-12-2015, 06:36 AM
 
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How is this news??? Drug formularies change every year. Personally, I never thought Viagra should have been covered under medical insurance in the first place, especially when that was covered but birth control pills were not (years ago).
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Old 08-16-2015, 01:16 PM
 
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Quite a few of the drugs on the list now have generic forms that are far cheaper. And a bunch of the others have same ingredients alternatives that are cheaper. So I think CareMark is doing prudent business by removing the expensive forms of the drugs.
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Old 08-17-2015, 11:38 AM
 
Location: Upstate NY 🇺🇸
36,764 posts, read 12,279,449 times
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Quote:
Originally Posted by Qwerty View Post
How is this news??? Drug formularies change every year. Personally, I never thought Viagra should have been covered under medical insurance in the first place, especially when that was covered but birth control pills were not (years ago).

Whether or not one thinks that Viagra ever should have been covered, that has nothing to do with birth control pills..The former is supposed to be prescribed for erectile dysfunction ; the latter, for.....well, birth control.
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Old 08-17-2015, 05:12 PM
 
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Originally Posted by Delahanty View Post
Whether or not one thinks that Viagra ever should have been covered, that has nothing to do with birth control pills..The former is supposed to be prescribed for erectile dysfunction ; the latter, for.....well, birth control.
sure...so men could have sex...that's medically necessary...just like what women were told about not covering birth control--it wasn't medically necessary
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Old 08-19-2015, 12:24 PM
 
Location: SW Florida
11,713 posts, read 8,510,679 times
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Quote:
Originally Posted by Qwerty View Post
sure...so men could have sex...that's medically necessary...just like what women were told about not covering birth control--it wasn't medically necessary
The differences in coverage for Viagra vs. birth control pills falls under third party payer traditional coverage for prescription drug coverage to treat an illness, disease or medical condition. Erectile dysfunction falls under that category as a medical condition, and like it or agree with it or not, a physiological function that "ain't workin" is a medical condition or abnormality.

Birth control medication used to prevent pregnancy is treating what? Would you consider pregnancy an illness, a disease, or a medical malfunction? None of the above, and hence the old reasoning by insurance carriers that these meds aren't covered. That all changed, of course, with Obamacare regulations.

Just explaining the rationale used for coverage or lack of same for these drugs. Not that I personally agree with this coverage. Birth control pills have also been used to treat any number of gynecological conditions and diseases, and should always have been covered by a patient's insurance, but too often it was not and it took a lot of perserverance to get past an insurance carrier's claims personnel on autopilot who automatically reject coverage on claims for this medication because they see it as "birthcontrolwedon'tcoverthat".

Personally, I always thought that birth control should be covered medication subject to the same deductibles and copays for any other covered prescription drugs. And I always believed that while it is true that Viagra is used to treat a medical abnormality, there had to be a political/other influential personage component to covering this drug for anyone and everyone-after all a lot of politicians/other movers and shakers are old men past their prime.

Anyway, apparently Cialis is still covered, and its a lot cheaper, apparently than Viagra. So those inclined can always be ready "when the time is right", for less money than that little blue pill.

Last edited by Travelassie; 08-19-2015 at 12:32 PM..
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Old 08-20-2015, 08:59 AM
 
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Back when I processed health insurance claims this would fall under "quality of life" issues, which were covered. A hip replacement is a good example. Is a hip replacement necessary to prolong life? No, a person will not die without a hip replacement, but their quality of life will be improved with one.

I suppose ED drugs would fall into the same "quality of life" for medications. A man does not need ED medications to prolong his life. Contraceptives would also fall into that same quality of life category, which when I processed claims, were also covered medications.
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Old 08-20-2015, 09:20 AM
 
12,802 posts, read 8,329,305 times
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Quote:
Originally Posted by John1960 View Post
List of excluded drugs has ballooned from 34 in 2012 to 124 in 2016

CVS drops Viagra, other drugs from insurance coverage | Money - Home
Viagra, Cialis and the like haven't been covered by most insurance companies for years. If covered it used to be 4 tabs a month.

I'm a Pharmacist and tell my customers to buy them 1-2 at a time. All cost over 25-30.00 a tab.

Now the real question here should be, will the new woman's pink pill be covered? (BTW, terrible mistake by the FDA caving in to woman's groups to release this med. Side effects and contraindications are bad.

But, FDA yielded to pressure by NOW, etc. Will the insurance companies yield? I bet they might


BTW, this list of excluded drugs: "Abilify (antipsychotic) Amitiza (irritable bowel disease) Avonex (multiple sclerosis) Bydureon (diabetes) Carac (dermatology) Cardizem, including Cardizem CD, Cardizem LA and its generic (high blood pressure) Clobetasol spray (dermatology) Clobex spray (dermatology) Cymbalta (depression) Diovan (high blood pressure) Exforge, including Exforge HCT (high blood pressure) Extavia (multiple sclerosis) Fluorouracil cream 0.5% (dermatology) Fortesta (testosterone replacement) Fosrenol (kidney disease) Incruse Ellipta (Chronic obstructive pulmonary disease) Intuniv (ADHD) Invokameet (diabetes) Invokana (diabetes) Matzim LA (high blood pressure) Monovisc (monovisc) Noritate (dermatology) Plegridy (multiple sclerosis) Qsymia (anti-obesity) Relistor (gastrointestinal) Valcyte (anti-infective) Viagra (erectile dysfunction Zubsolv (opioid dependence)"

All are high cost brand name meds. Some have lower cost alternatives available. A few have generics that are covered.

As a final thought, any med that you see advertised on TV are very expensive tier 4 drugs or not covered at all. That's why TV advertising is bad for the consumer in the case of prescribed meds.

Last edited by mike1003; 08-20-2015 at 09:30 AM..
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Old 08-20-2015, 12:16 PM
 
Location: SW Florida
11,713 posts, read 8,510,679 times
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Quote:
Originally Posted by mike1003 View Post
Viagra, Cialis and the like haven't been covered by most insurance companies for years. If covered it used to be 4 tabs a month.

I'm a Pharmacist and tell my customers to buy them 1-2 at a time. All cost over 25-30.00 a tab.

Now the real question here should be, will the new woman's pink pill be covered? (BTW, terrible mistake by the FDA caving in to woman's groups to release this med. Side effects and contraindications are bad.

But, FDA yielded to pressure by NOW, etc. Will the insurance companies yield? I bet they might


BTW, this list of excluded drugs: "Abilify (antipsychotic) Amitiza (irritable bowel disease) Avonex (multiple sclerosis) Bydureon (diabetes) Carac (dermatology) Cardizem, including Cardizem CD, Cardizem LA and its generic (high blood pressure) Clobetasol spray (dermatology) Clobex spray (dermatology) Cymbalta (depression) Diovan (high blood pressure) Exforge, including Exforge HCT (high blood pressure) Extavia (multiple sclerosis) Fluorouracil cream 0.5% (dermatology) Fortesta (testosterone replacement) Fosrenol (kidney disease) Incruse Ellipta (Chronic obstructive pulmonary disease) Intuniv (ADHD) Invokameet (diabetes) Invokana (diabetes) Matzim LA (high blood pressure) Monovisc (monovisc) Noritate (dermatology) Plegridy (multiple sclerosis) Qsymia (anti-obesity) Relistor (gastrointestinal) Valcyte (anti-infective) Viagra (erectile dysfunction Zubsolv (opioid dependence)"

All are high cost brand name meds. Some have lower cost alternatives available. A few have generics that are covered.

As a final thought, any med that you see advertised on TV are very expensive tier 4 drugs or not covered at all. That's why TV advertising is bad for the consumer in the case of prescribed meds.
Thanks for the list. I guess it's CVS (and its mail order prescription company Caremark) that are currently dropping these drugs from their coverage, I'd figure that it might only be a matter of time before other pharmacies do the same thing. I get my prescription drugs from Walgreens- we have our drug coverage through the federal employees (and retirees) BC/BS so we will see. I noticed Matzim LA on your list, and I take that, for som e reason figured it was a generic version of Cardizem-LA, but see it is another brand name form of diltiazem. I didn't realize it was one of the more expensive blood pressure meds out there, and no one at the pharmacies I have ever gotten it from ever asked me about substituting a generic form of the med. If it becomes an issue of noncoverage I will check with the doctor about substituting another drug.
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