What is a drug exclusion list?

A drug exclusion list is a list of medications that will not be covered by a health plan for any reason. The drug is not on formulary and there are no loopholes to gaining approval.

Why did CVS Caremark stop covering eliquis?

Editor’s note: The recent CVS Caremark decision to exclude Eliquis® (apixaban) from its Preferred Drug List raises critical patient safety issues about whether CVS is illegally practicing medicine and whether CVS actually cares about the patients it professes to serve.

What is a plan exclusion?

In a nutshell, an exclusion is a condition or instance that is not covered by your insurance plan. Just as each plan has a list of items that the insurance company will cover, they also have a list of items they will not.

What is a benefit exclusion?

Benefits Payable Exclusion — a standard exclusion in fiduciary liability policies precluding coverage for claims involving payment of benefits owed to a claimant, if monies are available within the plan to make such a payment.

What is the sad exclusion list?

The evaluation of drugs for addition to the self-administered drug (SAD) list is an ongoing process. This list contains only those drugs and biologicals that are determined to be “usually self-administered by the patients” and therefore not eligible for Medicare coverage.

Will there be a generic for Eliquis in 2022?

As the original manufacturers, they own a patent that prevents generics from being introduced until the patent expires. That patent was extended from February 2023 to November 2026. Both drug makers say that’s when generics can be made available.

Does Caremark cover Xarelto?

The covered preferred alternatives indicated by CVS Caremark are Xarelto®, also a Factor Xa inhibitor or warfarin.

What are common exclusions on health insurance policies?

Common Insurance Exclusions

  • Pre-Existing Conditions. Tip: If your pre-existing condition is considered excluded, you will not receive any benefits for related doctor visits, prescriptions, hospitalizations, etc.
  • Dental and Vision.
  • Maternity.
  • Alternative Medicine.
  • Sports.
  • Mental Health.
  • Outpatient Prescriptions.