Express Scripts announces 48 new formulary cuts next year as it shuffles coverage plan amid pricing debate

Express Scripts on Tuesday announced 48 new exclusions to its national preferred formulary starting January 1, 2019, including Gilead Sciences' triple combination HIV therapy Atripla (efavirenz/emtricitabine/tenofovir disoproxil fumarate), AbbVie's hepatitis C drug Mavyret (glecaprevir/pibrentasvir) and Sanofi's haemophilia treatment Eloctate (antihaemophilic factor (recombinant), Fc fusion protein).

According to the pharmacy benefit manager (PBM), pharmaceutical companies' "ongoing efforts to game the system by delaying generic competition, blocking safe and effective biosimilars and refusing to eliminate list price increases" are the main factors driving high drug prices in the US. It added that the changes to its 2019 formulary seek "to address these tactics by exposing opportunities within our national preferred formulary that will further improve affordability and access for payers and patients." 

Express Scripts spokeswoman Jennifer Luddy stated that the changes will raise the total number of excluded drugs to 242 next year, from 196 this year, and also factor in two currently excluded drugs that are being restored in 2019. The PBM said the excluded drugs include 22 therapies that have low-cost generic alternatives, as well as 11 specialty drugs for which a lower-cost branded alternative or biosimilar is available. Express Scripts also noted that there are 12 instances of brand-to-brand competition where the drugs have the same active ingredient, but the excluded drug carries a higher net price.

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Specifically, Express Scripts indicated that it will cover Mylan's HIV therapy Symfi (efavirenz/lamivudine/tenofovir disoproxil fumarate), which has a 40-percent lower list price than Atripla. The PBM also said its formulary will prefer Merck & Co.'s hepatitis C drug Zepatier (elbasvir/grazoprevir), whose price was reduced by 60 percent last month, as well as Gilead's hepatitis C treatments Harvoni (ledipasvir/sofosbuvir), Epclusa (sofosbuvir/velpatasvir) and Vosevi (sofosbuvir/velpatasvir/voxilaprevir) in place of Mavyret.

Express Scripts chief medical officer Steve Miller stated "high drug prices are one reason that the US spends more per capita on healthcare than any other developed nation," adding that "formularies such as our national preferred formulary…can help Americans save significantly on their healthcare costs without sacrificing quality or care." 

Earlier this month, CVS Health indicated that it would remove 23 additional drugs from its primary list of covered drugs in 2019, while resuming coverage for four other products that are not covered this year. The company is expected to unveil its list of excluded drugs in October. 

The news comes after US President Donald Trump unveiled proposals seeking to lower drug prices in the country, with the US administration also considering a plan to eliminate protections that allow drugmakers to provide rebates to PBMs and insurers. Additionally, the Pharmaceutical Research and Manufacturers of America recently outlined a new policy position seeking to change how compensation is calculated for PBMs and other parties in the supply chain. 

For related analysis, see ViewPoints: AbbVie is suddenly the shrinking violet in HCV, while Merck & Co. gets validation.


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