I have a work based plan with Aetna for medical and Express Scripts for pharmacy benefits. Accredo is the specialty pharmacy I am required to use for Cosentyx.
Late last year I began to receive notices from both Novartis (the manufacturer) and Express Scripts that my Cosentyx would no longer be a part of the formulary for 2021. A google search will also back up the fact that ER has made these changes.
I was prepared to fight to stay covered, but to my surprise, I was able to fill the prescription with no issue in January, February, and March. I have asked ER and Accredo multiple times about this supposed formulary change, but they insist I am good to go.
While I am of course pleased with this, it also makes me wonder if there is any chance of an unwelcome surprise. The Rx is $6k/month. Is there any additional due diligence needed on my end?
submitted by /u/Exacta7
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I have a work based plan with Aetna for medical and Express Scripts for pharmacy benefits. Accredo is the specialty pharmacy I am required to use for Cosentyx. Late last year I began to receive notices from both Novartis (the manufacturer) and Express Scripts that my Cosentyx would no longer be a part of the formulary for 2021. A google search will also back up the fact that ER has made these changes. I was prepared to fight to stay covered, but to my surprise, I was able to fill the prescription with no issue in January, February, and March. I have asked ER and Accredo multiple times about this supposed formulary change, but they insist I am good to go. While I am of course pleased with this, it also makes me wonder if there is any chance of an unwelcome surprise. The Rx is $6k/month. Is there any additional due diligence needed on my end?
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