CVS Health said that its pharmacy benefit management (PBM) unit CVS Caremark will initiate a programme allowing clients to exclude drugs launched at a price of more than $100 000 per quality-adjusted life year (QALY) as determined by the Institute for Clinical and Economic Review (ICER).
According to CVS, the programme is designed to "put pressure on manufacturers to reduce launch prices to a reasonable level," with the firm hoping that more PBM clients will adopt similar programmes. CVS said that the initiative will focus on expensive, "me-too" medications that are not cost effective, and will not apply to drugs deemed "breakthrough" by the FDA.
CVS noted that 'launch prices have been steadily rising for years, and are completely up to the discretion of the manufacturer." The company indicated that the average launch price of the last three approved oncology products in the US was around $145 000, with costs per QALY moving into the range of $300 000 to $500 000 range, which CVS said the healthcare system "simply cannot absorb."
The changes from CVS come after the PBM Express Scripts announced  last week 48 new exclusions to its national preferred formulary starting January 1, 2019. Express Scripts noted that there are 12 instances of brand-to-brand competition in the new exclusions, where the drugs have the same active ingredient, but the excluded drug carries a higher net price.