CVS and Express Scripts Release 2017 Formulary Exclusion Lists

Two of the nation’s largest pharmacy benefit managers (PBM) released updates to their drug formulary exclusion lists for the coming year.

Express Scripts excluded 85 drugs from their 2017 National Preferred Formulary (NPF) list. The PBM said that customers will see only small changes in coverage, but this will add value to their plan, according to a press release.

Express Scripts predicts that only 0.12% of customers will have to use an alternative treatment than what they are currently receiving. However, the PBM added that they have created a way for patients to have their medications covered if they have a rare clinical need.

Excluded in the formulary are drugs used to treat common conditions, such as diabetes and inflammatory conditions. The 85 excluded products represents a slight drop from the 87 excluded products last year. By comparison, CVS excluded 154 drugs for their 2017 formulary, up from 124 products last year.

Even some hepatitis C virus (HCV) treatments are being excluded, but Express Scripts states that they will continue to review the category as more treatments receive FDA approval. Viekira Pak for HCV genotype 1 and Technivie for HCV genotype 4 were classified as the preferred agents on the Express Scripts formulary, while CVS stuck with Sovaldi and Harvoni.

CVS has shown a preference to lower costing biologics and follow-on biologics for their 2017 formulary, according to their press release. They are planning to drop Lantus, an insulin treatment, and Neupogen, a drug that prevent infections in patients with cancer, from their coverage.

Instead they are covering the biologic and follow-on biologic versions, Basaglar and Zarixo to treat the respective conditions. While Express Scripts continues to cover oncology drugs such as Gleevac, CVS has chosen to exclude this particular drug from its formulary, likely because there is a generic version available.

Also, they CVS said in a press release that they are “taking a stand” against hyperinflationary drugs. CVS plans to evaluate these drugs and remove them if there is a cost-effective alternative.

They are also planning to evaluate and remove generics that are produced by a small amount of manufacturers, which can drive costs up. Other specialty drugs CVS excluded from its formulary were the oncology drug Xtandi and Tobi Podhaler/Tobi, a cystic fibrosis drug.

Express Scripts said in the press release that the only medications excluded from the formulary have a clinically equivalent alternative, and they project that plan sponsors will save $1.8 billion during 2017 because of the exclusions.

Both pharmacy benefit managers expect to see great cost savings for their customers as well as increased competition for lowering prices in the coming years.

Express Scripts Excluded Medications/Products at a Glance:

Abbott (FreeStyle, Precision); Abstral; Acuvail; ADV MED TECH (TRUEtest, TRUEtrack); Advocate; Alogliptin; Alogliptin/Metformin; Alvesco; Apidra; Aranesp; Asacol HD; Bayer (Breeze, Contour); Beconase AQ; Bravelle; Cetraxal; Cimzia; Colchicine; Daklinza; Delzicol; Dipentum; Doxycycline 40 MG Capsules; Duexis; Endometrin; Epogen; Estrogel; Evzio; Fentora; Fluorouracil 0.5% Cream; Follistim AQ; Fortesta; Ganirelix; Acetate Gel-One; Genvisc 850; Glumetza; Hyalgan; Hymovis; Istalol; Kazano; Kineret (Exclude for RA); Kombiglyze XR; Levitra; Mircera; Natesto; Nesina; Novolin; NovoLog; Nutropin AQ; Olysio; Omnaris; Omnis Health (Embrace, Victory); Omnitrope; Onglyza; Orencia; Pancreaze; Pertzye; Proventil HFA; Qsymia; ribasphere ribapak; RibaTab; Roche (Accu-Chek); Saizen; Simponi 50 MG; Sovaldi; Staxyn; Stendra; Subsys; Supartz; Supartz FX; Synvisc; Synvisc-One; Taltz; Tanzeum; Testim; Testosterone Gel; Ultresa; UniStrip; Veltin; Veramyst; Victoza; Vimovo; Vogelxo; Xopenex HFA; Zepatier; Zetonna; Zioptan; Zomacton; Zyclara

CVS’ Excluded Medications/Products at a Glance:

Butalbital/APAP/Caffeine Capsules (All Brands and Generics, not tablets); Xtandi, Nilandron oral tablets; SNRI’s Venlafaxine ER Tablets, except 225mg (All Brands and Generics); Crestor (MSB); Dutoprol oral tablets; Carnitor/ Carnitor SF oral solution (MSB); Gleevec (MSB), Tasigna; Xenazine (MSB); Neupogen, DexPak oral tablets, Millipred/ Millipred DP oral tablets, dose pack and oral solution; Tobi Podhaler/ Tobi (MSB), Alcortin A gel, Aloquin gel, Novacort gel; Helixate FS, Daklinza, Olysio, Technivie, Zepatier; Amitiza; Lantus, Toujeo; Dymista, Duexis, Vimovo; Abstral; Evzio; Pradaxa; Enablex (MSB), Gelnique, Toviaz; Opsumit; All non-Becton Dickinson pen needles and syringes; Klor-Con oral pack for solution; Nexium (MSB), Zegerid oral suspension and capsules (MSB); Proventil, Ventolin