CVS Caremark To Drop 31 Prescription Drugs From Formulary in 2016
Pharmacy benefit manager CVS Caremark next year will omit 31 additional medications from its coverage, Reuters/New York Times reports.
Among the medications removed from the PBM's formulary are some commonly used diabetes and multiple sclerosis treatments, such as:
- Invokamet; and
In addition, Caremark will no longer cover the erectile dysfunction treatment Viagra or the weight-loss drug Qsymia (Reuters/New York Times, 8/6). The formulary will also exclude coverage for:
- Abilify, an antipsychotic;
- Amitiza, used to treat irritable bowel disease;
- Cymbalta, used to treat depression;
- Diovan, used to treat high blood pressure; and
- Fosrenol, used to treat kidney disease.
The changes will take effect on Jan. 1, 2016 (Thadani, USA Today, 8/6). At that time, most beneficiaries who would like to use the excluded drugs will likely have to pay full price. However, there could be some exceptions, such as:
- If patients and their physicians demonstrate medical need for a particular drug; or
- If beneficiaries' plans have special formularies that differ from the company's general offerings (Loftus, Wall Street Journal, 8/6).
CVS spokesperson Christine Cramer said although certain drugs were removed, the PBM will continue to cover "equally effective products with lower overall costs" (USA Today, 8/6). For example, while the company will no longer cover Pfizer's Viagra, it will cover Cialis, a different erectile dysfunction treatment sold by Eli Lilly.
According to Reuters/Times, PBMs often drop drugs from their formularies if they can no longer obtain them at favorable prices (Reuters/New York Times, 8/6).
Geoffrey Porges, an analyst at Sanford C. Bernstein, said excluding medications from formularies can be a "potent weapon" for PBMs. He anticipates the practice will grow, with the number of drugs excluded by at least one of the two largest PBMs in the U.S. projected to increase from 130 this year to 165 in 2016.
Express Scripts CMO Steve Miller noted PBMs are "often able to extract over-sized discounts from the pharma manufacturers" by threatening coverage exclusions (Wall Street Journal, 8/6).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.