Arthritis Foundation Continues to Monitor Health Benefits

March 20, 2014 – As part of our commitment to ensure people with arthritis have access to the treatments they need, the Arthritis Foundation continues to monitor the coverage and policies of major insurers and pharmacy services.  We recently followed up with leadership at Express Scripts regarding the formulary changes they put in place at the beginning of 2014 Read more here. Express Scripts reports generally positive responses from plan sponsors (typically employers), physicians and patients, with out-of-pocket expenses remaining about the same as before the changes. The response, in part:

"…patients who were already receiving specific arthritis medications in 2013, continue to access those drugs at a discounted price in 2014. [Their] medication access and out-of-pocket expenditures have generally remained the same. For new patients, Express Scripts works with them and their health care provider to identify medically reasonable alternatives (typically Enbrel and Humira). If, for whatever reason, there is a medically necessary reason to access an excluded drug, physicians work directly with Express Scripts via our formulary exceptions and appeals processes. Based on our 2014 experience, the preferred alternatives have been well received for the vast majority of patients."

Help us help you by letting us know your experience in accessing the treatments you need.  Have you experienced barriers from your insurer or pharmacy provider?  We want to hear your stories – good or bad!  Contact us at arthritisfoundation@arthritis.org.  Please put “Access to Treatment” in the subject line. 

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