How would BCBS select which drug out of two similar options to "prefer"?

My limited understanding of prescription drug coverage is that each insurance company places each drug in a pricing tier. On one end you have extremely expensive drugs that you'll be hard pressed to ever get the company to agree to cover. On the other you have common, cheap, generic drugs that they cover entirely or for a few bucks. In the middle you have somewhat expensive drugs that the company may cover, but you have to get a doctor to explain why you have to have THAT exact drug and not a similar cheaper one.

I have BCBS Alabama through my employer and I take both short and long term insulin for type 1 diabetes. Until the first of this year, they preferred the short term Novolog (made by Novo Nordisk) and the long term Basaglar (made by Eli Lilly.) Upon attempting to refill my Basaglar today, the pharmacist informed me that BCBS has changed its preferred long term to Lantus (made by Sanofi.)

What criteria does an insurance company use to decide these matters? The conspiratorial part of me is finding it really suspicious that Eli Lilly just announced a $35 cap on co pays for all its insulins, including Basaglar, and whoopsie BCBS suddenly prefers another drug whose copay is going to be more expensive for me. Like, does Eli Lilly and all the other drug manufacturers strike deals with insurance companies to get their drugs treated preferentially? And if I'm being too conspiratorial here then what actually occurs?

In case it matters, I turned 30 last week and I am a female living in west Alabama.


submitted by /u/kaylajacs