Express Scripts Releases 2018 Formulary Exclusion List

Formulary lists are an effective way pharmacy benefit managers (PBMs) control spending on prescription drugs. While PBMs employ different approaches to creating the list, most choose to cover drugs that result in optimal patient outcomes.

For Express Scripts, an independent panel makes recommendations and the PBM negotiates drug costs with pharmaceutical manufacturers to ensure that the treatments are appropriate and cost-effective, according to a company press release.

Review Express Scripts’ 2017 formulary.

The process to create the National Preferred Formulary (NPF) incorporates data analytics, pharmacological evidence, and predictive modeling, according to Express Scripts.

The PBM announced they will be excluding an additional 64 drugs, bringing their total number of exclusions up to 159; however, Express Scripts notes that they exclude a small percent of the 3791 available drugs, according to the release.

Although there are new exclusions being introduced this year, 99.2% of Express Scripts patients will not be affected by the decisions.Those taking drugs that are excluded will be asked to switch to a covered medication that achieves the same result; however, if a patient requires treatment with an excluded drug, there is a pathway that allows the patient to obtain the necessary therapy.

As a result of the new exclusions, Express Scripts reports that employers will save an additional $2.5 billion in 2018, according to the release.

In 2018, the PBM required brand manufacturers to provide significant savings if there are lower-cost generic competitors. Due to this, there were 46 multi-source branded drugs excluded, including aripiprazole (Abilify), clopidogrel (Plavix), and sertraline (Zoloft).

The other 18 drugs excluded are single-source brand exclusions, including plecanatide (Trulance), teriparatide (Forteo), and lansoprazole (Prevacid Solutab), according to the NPF.

Express Scripts has also chosen to remove filgrastim (Neupogen) from the formulary in favor of tbo-filgrastim (Granix) or filgrastim-sndz (Zarxio), which is a biosimilar to the branded drug. Since biosimilars are less costly with comparable efficacy, many payers prefer them over the reference product.

The PBM noted that placement of hepatitis C drugs and those that treat inflammatory conditions are still under review and have not been included in the initial report, according to the exclusions list.

The generic versions of the following brand name medications are covered on the Express Scripts preferred formulary:

• Abilify
• Aciphex
• Adderall
• Androgel 1%
• Anusol-Hc
• Atacand, Atacand HCT
• Azor
• Benicar, Benicar HCT
• Bupap
• Cymbalta
• Cytomel
• Effexor XR
• Imitrex
• Inderal LA
• Intuniv
• Lexapro
• Librax
• Lidoderm
• Lovenox
• Lunesta
• Minastrin 24 FE
• Nasonex
• Plaquenil
• Plavix
• Prevacid
• Pristiq
• Protonix
• Provigil
• Prozac
• Pulmicort Respules
• Seroquel, Seroquel XR
• Singulair
• Strattera
• Tikosyn
• Tobi Solution
• Tribenzor
• Valium
• Valtrex
• Vytorin
• Wellbutrin SR
• Xanax, Xanax XR
• Xenazine
• Zegerid
• Zetia
• Zoloft
• Zyflo CR