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New generics meds not available from Medicare part D providers

I recently became aware of the generic replacement for Advair manufactured by Teva.  Fluticasone Propionate and Salmeterol Inhalation Powder (Multidose Dry Powder Inhaler),  I had my doctor call in a prescription to Humana and they refused to fill it because it was not on their formulary.  I appealed and they still denied it.  This new year I changed from Humana to BCBS of South Carolina.  When I was able to review their 2018 formulary it was not on there.  I called them and they say the same thing.  I don't get it, usually they are pushing the generics.

Has anyone else had this same problem?

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  • K8sMom2002

    That is odd … thanks for sharing this! Is the brand name of the medication on the formulary, or are you having to do without? 

  • Dennis

    Teva came out with both a Brand and generic form of Fluticasone Propionate and Salmeterol mid last year and so far neither has shown up on the South Carolina Medicare Part D formulary.  I am taking a more expensive Brand, Symbicort or Advair.  The generic is half the cost of the brands and would save me considerable medicine costs.  I am trying to figure out who to contact in SC Medicare to find out what's going on.

  • Megan Roberts

    HI @Dennis I take the same medication (generic version) for the same reason as you, it is a few hundred dollars cheaper than Advair. I found a coupon for it at GoodRx.com which made it around $50 ($48 I think) without using health insurance. I get the Rx filled at Walgreens, because it is cheapest there, and I no longer even need the coupon to get that price for it. Do you have to get the prescription through Medicare or could it be an option to fill the medication outside that system? 

    At first the pharmacy did have to special-order the medication, because it just came out a few months ago. Now they carry it. 

    Good luck in petitioning to get this added to the formulary or obtaining it through other methods. This med has worked very well for me so far and was really my only affordable option. 

  • Jen

    @Dennis Welcome to AAFA's support forums.   That medication situation sounds frustrating.  Do you think your doctor's office may have some ideas as to who you should call?

  • Dennis

    Thanks Megan for your response.  I did find the Good RX deal and will consider using it.  It just aggravates me that it is not covered by Medicare.  I read that now these Brand drugs patents are running out the drug companies are making better deals with suppliers, but it does not trickle down to us users.  We need to complain and change this.  I submitted a complaint to my state medicare.  I doubt anything will come of it.  Thank you for your info.

    Dennis

  • K8sMom2002

    Good for you, Dennis! Fingers crossed that something WILL come of it.

    I take it that the generic was never on the formulary to begin with, so it wasn't a question of it being removed?

    I know from year to year medications will be added or removed from insurance formularies … and in fact, my insurer tells us that it can happen at any point during the year. 

  • Megan Roberts

    I can totally understand your aggravation. Best of luck with advocating for yourself and in finding the most affordable version of this med, @Dennis. Let us know what happens with this. 

  • Dennis

    Update 1/11/18

    So I sent in a question to my state Medicare asking why the generics are not available through the providers yet.  Here is their answer.  Bottom line – NO HELP from the state of South Carolina Medicare.  The big Pharm. companies and Drug plan providers obviously operate with impunity.  This guy did a pretty good job of providing lip service, but that's about it.  So where do you go from here?  State representatives?   I don't know.  Who fights for us anyway?

    Hi Dennis,

    Yes, I remember when the generic Advair inhalers were released.But unfortunately, I cannot provide you with a definite answer as to why thegenerics are not included on all Medicare plan formularies.In short, each Medicare Part D plan has a specific strategy behind whatmedications are added or removed from their formularies each year, but sincewe are not involved with this process, we can only speculate as to why a newmedication, lower-costing drug has not been included on a specificformulary.We often track the release of new generics – and the number of Medicare PartD plans that include the new drugs in their formularies.  As a trend, it cantake up to several years before a new medication is universally includedinto plan formularies as a substitute for the name-brand medication.Remember that you do have the right to ask for a formulary exception wherebya non-formulary medication would be covered by your Medicare plan.  But, youmay find that the final cost of the non-formulary drug would be rather highas the cost-sharing would be that of the higher drug tiers.For example, if your formulary exception request was granted, you may havethe generic drug treated as a Tier 4 drug with a cost of 25% to 50% ofretail – as compared to using the brand-name drug.

     

  • Jen

    Ugh Dennis.  Sounds so frustrating!  Now…I have to wonder exactly who at the state Medicare it was that answered your question.  Maybe there is someone higher up with more information who could help.

  • K8sMom2002

    Dennis, thanks for sharing that with us … what's your plan? Do you plan on asking for the formulary exception?

  • Dennis

    Good news.  I complained to my state senator Lindsey Graham, S.C. about two weeks ago about the state and Part D suppliers not having this new generic on their formulary.

    Today I received a call from Blue Cross Blue Shield of SC (my part D provider) and they will add the generic to it's formulary.  They will contact my doctor and set up the prescription.  So It does pay to use your local politicians to help you out.  I am impressed by the almost immediate action by my senator and will thank him for his actions.

  • Megan Roberts

    Wow — that's incredible news, @Dennis! Thanks so much for this update. Congratulations on scoring a huge win by being resourceful and reaching out to your elected representative. It's really important to hear that advocacy efforts like that actually pay off. Even though you were just trying to obtain affordable meds, I'm sure your actions will end up helping others, as well. Well done, and congrats on gaining access to an affordable version of the med that will help you control your asthma.

  • K8sMom2002

    Woohoo! I'm so glad you're going to get the medications you need, and that your elected officials were there for you!

    And just think — you helped out other folks in your exact same shoes! You're definitely an Asthma Warrior!