Prescription drug formulary to change April 1

Published: January 15, 2014

Express Scripts, Inc. (ESI), the administrator of the University’s prescription benefit program, periodically reviews its formularies – lists of covered medications – to stay abreast of pharmaceutical developments and to manage rising costs. Formularies are commonly revised to remove more expensive brand-name drugs after their lower-cost generic equivalents become available.

Effective April 1, 2014*, several drugs will be excluded from ESI’s formulary and will no longer be covered. Most members of the University’s prescription benefit program will not be impacted. Members who will be impacted include those who are currently prescribed one of the excluded drugs (PDF*).

If you are prescribed a drug that is excluded from the ESI formulary, you may: 1) switch to a preferred alternative; 2) ask your healthcare provider to request a clinical exception; or 3) continue with the excluded drug by paying the full undiscounted cost of the drug. Covered alternatives will remain available for every drug removed.

ESI is sending impacted members a communication that lists covered alternatives. Members who are not impacted will not receive this communication.

Selecting among medication options is an important decision that you should discuss with your healthcare provider. For additional help, contact a Notre Dame Wellness Center pharmacist at (574) 271-5622. The pharmacists at the Wellness Center are familiar with ESI’s formulary, can suggest alternatives, and will work with you and your physician to find an alternative or request a clinical exception.

Additional Information

For more information about Notre Dame’s Prescription Drug Benefit, visit the HR website, or contact askHR at (574) 631-5900 or askHR@nd.edu.

Frequently Asked Questions

What is a formulary? A formulary is a list of preferred medications. These prescription drugs, generic or brand-name, are selected by a panel of physicians and pharmacists for their demonstrated efficacy, safety, and cost-effectiveness. Listed drugs are generally available to the patient at a lower cost than drugs not listed. Approximately 500 brand-name medications – and every generic medication – are listed on ESI’s National Formulary.

Are drugs on the formulary covered? Yes, although coverage differs between generic drugs, preferred brands, non-preferred brands, or specialty drugs. See Notre Dame’s Prescription Drug Benefit for more information.

What is a clinical exception, and how do I request one? If you are prescribed an excluded drug, an exception may be granted if certain clinical criteria or circumstances are met. Your physician may submit an override request explaining the clinical need for the drug to ESI’s Coverage Review Determination team. For more information about clinical exceptions, contact Express Scripts, Inc.

*Express Scripts’ literature indicates the exclusions are effective January 1, 2014. For members of the Notre Dame prescription drug plan, the exclusions are not effective until April 1, 2014.