Medco Pharmacy and Tier 3 Drugs

On January 1, 2011, my insurance, United Healthcare, who uses Medco as their mail order pharmacy, made the decision that the type of insulin that I use, Novolog is a tier 3 drug.  What does that mean?  That means that instead of last year when I paid $25 for a 3 month supply, I now pay $150 for a 3 month supply.  I noticed that Humalog, which I used to use before I went on an insulin pump, is still a tier 1 drug and still costs only $25 for a 90 day supply.  When I asked why Novolog was bumped up to a tier 3, they said they didn’t know, which I didn’t expect that exact person to know, but somebody had to know and there had to be some sort of documentation out there on why this was bumped to a tier 3.

I still have not been able to find any information, so I am just curious as to why one is considered one thing and the other is not.  I don’t think there is some sort of huge conspiracy here, I just want to know.  Is there a possibility that it could be that more people use Novolog, so that way they charge more for it?  Or they don’t have a good relationship with that manufacturer and they don’t get as good of a deal on it?

Does anybody have any information on this?

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5 thoughts on “Medco Pharmacy and Tier 3 Drugs

  1. Hey Chris. Sorry you got hit by that change. I’m with UHC currently myself, but am a Humalog user and so still under that Tier 1 umbrella. I am by no means the expert on any of this, but have just heard from others that it may very well be just a “way it works” kind of thing… with Lilly sales reps sealing a deal more with UHC than Novo did and therefore, getting to keep that Tier 1 status and not get bumped down to a more costly level. Can’t say I know if this is true or not, but I’ve heard it from some reliable people who say it is likely a big part. There’s also been lot of discussion over at the CWD forums on this, but can’t point to the exact spot where that’d be – probably in the parent Type 1 area. Hope it can get moved down again, but sorry for the crappy cost this hits you with now.

  2. Actually, it’s because Eli Lilly & Co. cut United Healthcare a deal, so that Humalog (and Humulin for those who still use that) is now much, much cheaper for them than is Novolog (and Novolin). It’s pure economics. Previously, Novo was the aggressor when it came to cur-rate pricing for insulin (only to later raise prices by 100% or more), and now Lilly is fighting back.

  3. From my experience in benefis enrollment and Medco, Novolog is now considered more of a “premium” insulin. Medco sees it as a as more of a choice to use it rather than a slightly slower acting insulin like Humalog. Like you pay more for Verizon and AT&T than you would for T-Mobile or Sprint. I’ve had that question come up from people and I’ve pushed for an answer too, but that’s the best I have been able to get out of anyone in the business. It makes it easier on the back end for prescription carve out plans to change the drug formulary rather than adjust the copay for an entire tier, but ultimately it’s all the same. It comes down to money, and “that’s just how the business works.”

  4. I’ve used the humalog before and it caused my glucose level to fall too fast and pass out and end up in the ER. Novalog has been a better way to mange my glucose levels without many adverse affects. MEDCO has dropped the novalog and is trying to force me back on humalog. I only hope that my wife sues them after my death from being forced to use humalog.

  5. Another obamacare side affect. Cigna Healthspring and BC/BS have also (starting in Jan. 2014) made Humalog a Tier 3 drug. Very disturbing trend. What’s next?

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