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CVS and Express Scripts Release 2017 Formulary Exclusion Lists

Express Scripts has 85 drugs excluded from its formulary list, compared with 154 for CVS.
Published Online: Aug 03,2016
Laurie Toich, Assistant Editor
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.