Express Scripts is a widely known, and widely utilized, prescription plan provider. Recently they announced they were adding some new drugs to their “excluded” list which means they may not be covered in formularies.

Starting in 2014 Express Scripts excluded certain medications because of cost concerns. In 2016 there were 87 drugs on the exclusion list and in 2017 they announced there will be 85 drugs on the list.

Some of the recently excluded drugs include Orencia for arthritis, Taltz for psoriasis and a cream treatment for the skin condition actinic keratosis called Zyclara. Zyclara can cost over $1,000 per tube. Express Scripts says that by using this exclusion list they could save customers $1.8 billion in 2017.

Some drugs that were on the excluded list last year are going to be available next year, according to the provider. Drugs like Xeljanz for arthritis and asthma drugs Arnuity Ellipta and Floven Diskus. Those drugs will be labeled “preferred alternatives” after Express Scripts and drug manufacturers negotiated pricing. Diabetes drugs from one producer Novo Nordisk are still on the exclusion list though diabetes medications from Eli Lilly are covered, perhaps because of negotiated discounts.

The Express Scripts 2015 Workers’ Comp Drug Trend Report shows that Hepatitis C medication was at an 85.1 percent trend between 2014 and 2015, a combination of utilization and price. Compound medications, which can be very costly and typically need approval since they are not always on formularies, decreased in trend that year to 33 percent. Overall workers’ comp drug utilization trend was low, 2.2 percent that year. Spending on specialty medication can be high even though they make up such a small percent of overall utilization, and drugs for Hepatitis C or other antiviral drugs were at a 49.5 percent trend that year because of a 38.4 percent increase in cost and an 8.1 percent increase in utilization.

These changes may affect patients who are on certain medications, or who would like to be on certain medications and may have to consider an alternative or seek approval.

Here is the list of excluded medications and their preferred alternatives for 2017.