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My insurance company wants me to switch aromatase inhibitors! Why!

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I've been on exemestane for almost 4 years, tolerating it remarkably well.

Just got a letter from my insurance company. Starting in January, exemestane is "non-preferred" and will cost me more. The insurance company suggests I "switch to anastrozole."

I'm angry! I don't want to switch medications, given that the one I'm on is miraculously side-effect-free for me, which is so RARE. We all know that AIs can have many side effects, and each of the three main AIs affects different women in different ways… so why risk switching now?? UGH! Insurance companies are so infuriating! Why the heck would my medication suddenly become "non-preferred"??

Any advice? Should I suck it up and try anastrozole, to save money, even though the possibility of side effects with a new drug gives me anxiety? Should I find a way to pay for the exemestane, because I know I can tolerate it? Can my doctor (or someone else on the "breast cancer treatment team") badger my insurance company to continue covering the exemestane as they have been?

Comments

  • maggie15
    maggie15 Member Posts: 1,015
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    Hi @raili , Unfortunately this happens since pharmacy benefit managers make deals with drug companies to use their med to cover a class of drugs an insurer must provide. They publicly claim it saves money but the PBM gets a kickback so that the insurance company gets a better price and the pharmaceutical company makes money on the volume of prescriptions. You and your doctor can ask for a formulary exemption and, if that is denied, you can file an appeal.

    In my experience the insurer will make you try anastrozole to see how it works. If it is OK all is well. If you end up with intolerable side effects document them and have your doctor file for a formulary exemption. If that is denied, file an appeal. If the appeal is denied and you want to continue with exemestane check out the online coupons that are offered outside of your insurance like GoodRx, Optum Plus, SingleCare, ScriptSave WellRX and Blink Health. Sometimes your pharmacy is affiliated with its own savings program. You might have to change pharmacies to get the best deal. Also, prices can change monthly so it requires frequent checking. I get 3 months at a time (the max allowed) since it is less volatile. Some medications are available at a discount mail order pharmacy like CostPlus but I have never had luck there. Some people use Canadian mail order pharmacies successfully but you have to be careful doing this.

    If you have employer provided insurance it is sometimes worthwhile to complain to HR who will pass it along if they notice a trend. This year I have had one exemption granted and I pay out of pocket for another prescription (being taken off label so appeal was denied) using GoodRX. It seems unfair but it's worth preserving my QOL by paying $200 rather than the $2000 my insurance pharmacy would charge monthly. Good luck!

  • hippmark
    hippmark Member Posts: 93
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    I just switched from Anastrozole to Exemestane due to side effects. I'll be going on Medicare Jan. 1. Medicare doesn't want to pay for it either. I found I can get it at Costco for $55 a month. Still too much, but better than retail at $431 a month.

    Im enjoying Exemestane. Much more tolerable, at least for me.

  • raili
    raili Member Posts: 96
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    Maggie, thank you so much for all of that information! That's so helpful.