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Express Scripts Announces Formulary Exclusions for 2019, Drops Nearly 50 Drugs

The nation’s largest pharmacy benefit manager, Express Scripts, has announced they will drop approximately 48 drugs in 2019 from its current lineup of covered drugs, according to a company press release.

“Among the changes that take effect January 1, [2019] are 48 new formulary exclusions that will help payers better manage medication spending while preserving patient access to effective therapies,” Express Scripts wrote.

Specific drugs included in the exclusion list are Gilead’s HIV treatment Atripla, AbbVie’s popular hepatitis C treatment Mavyret, and Sanofi’s hemophilia treatment, Eloctate.
Further exclusions include:

  • 22 drugs that have low-cost generic alternatives;
  • 12 instances of brand-to-brand competition where the drugs have the same active ingredient, but the excluded drug has a higher net cost;
  • 11 specialty drugs that have a lower-cost brand or biosimilar alternative with a lower list price;
  • 10 drugs that are multisource brands with direct generic equivalents; and,
  • 9 short-term therapies, such as topical creams and ophthalmic treatments.

“After clinical considerations, formulary preference is given to high-value therapies with the lowest net cost for clients, achieved through low list price, rebate or both,” the company press release said.

Express Scripts explained that in addition to their formulary exclusions, they are also delivering value by passing roughly 95% of all pharmaceutical purchase discounts, price reductions, and rebates back to their commercial and health plan clients and their members. They noted that this process helped clients achieve a drug trend of 1.1% during the first half of 2018.

Similar to Express Scripts, CVS Health recently announced it will remove 23 drugs from its main list of covered drugs in 2019 and also bring back four drugs that are currently not covered, Bloomberg reported.—Julie Gould

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