CVS Health Announces 2018 Formulary Management Strategy

08.01.17

In the current era of high launch prices for prescription drugs and continued escalation in existing brand drug prices, CVS Health remains focused on ensuring patients get access to the medications they need at the lowest possible cost. One way we help deliver on this promise is through the formulary management strategies implemented by CVS Caremark, our pharmacy benefit management (PBM) company.

For 2018, we are removing 17 drugs from our Standard Control Formulary. Since the introduction of our industry-leading and rigorous approach to formulary management in 2012, through 2018, our formulary strategy is expected to deliver $13.4 billion in cumulative savings to PBM clients, through the inclusion of lower cost brands and encouraging the transition to generics.

Our Process

The guiding principles of our formulary strategy continue to be maintaining clinical integrity in order to provide access to clinically appropriate drug options for our millions of plan members, while reducing pharmacy costs for plan sponsors and members. When reviewing our Standard Control Formulary, we examine the drugs needed to treat all conditions and consider a range of factors including whether there are other clinically appropriate, cost-effective drugs available. We also use our size, scale and expertise to negotiate better prices for individual drugs from manufacturers, on behalf of clients.

The decision-making process includes an extensive review of scientific evidence, peer-reviewed medical literature and accepted clinical practice guidelines. In addition, most plans include an exception process for patients and their physicians that allows them to use drugs that are not on the formulary when it is medically necessary. Decisions regarding the drugs included on our managed formularies and the exception criteria are reviewed and approved by the CVS Caremark Pharmacy and Therapeutics Committee, an external, independent advisory board of physicians and pharmacists. For those drugs that are removed, clinically appropriate drugs with lower overall costs remain available on the formulary. For 2018, 99.76 percent of our members will be able to stay on their current therapy.

CVS Caremark is the largest pharmacy benefit manager in the country, in lives and claims, providing coverage to nearly 90 million plan members. Our range of managed commercial formularies, including Standard Control Formulary, covers more than 31 million members.