PBMs unveil 2017 formularies, retain focus on exclusions

 

Pharmacy benefit managers Express Scripts and CVS Health remain focused on using exclusions to help address drug costs.

The PBMs this week released their 2017 formularies detailing which drugs they plan to reimburse on behalf of insurers. CVS will exclude 155 drugs in 2017, and Express Scripts plans to exclude 85 drugs in 2017. Express Scripts will exclude two less drugs next year, while CVS Health added 31 new drugs to its exclusion list. 

CVS said that it now plans to target “hyperinflationary drugs,” and that it will evaluate treatments with “egregious cost inflation” on a quarterly basis and potentially remove them from its formulary.

Among the biggest changes, Pfizer's rheumatoid arthritis drug Xeljanz made the jump to a preferred alternative on Express Script's 2017 list after being excluded in 2016.

Express Scripts spokesperson David Whitrap wrote in an email that the “pricing that our clients will receive for these [preferred alternative] products in 2017 is now competitive for the class,” signaling that a price drop or rebate for Xeljanz may have been behind its new status. He added that the formulary changes for 2017 will affect less than 1% of its members.

Xeljanz is the only JAK inhibitor approved to treat rheumatoid arthritis, although another JAK inhibitor, Eli Lilly's baricitinib, was submitted in January for FDA approval.

Pfizer reported in its second-quarter earnings call that Xeljanz had U.S. sales of $189 million — a 63% increase from the same period a year ago, when it brought in $116 million in sales. Credit Suisse analyst Vamil Divan said revenue for Xeljanz was “surprisingly strong.”

One of the other shoes to drop is Sanofi's best-selling insulin Lantus, which CVS has elected not to cover in 2017. CVS said it will switch to Eli Lilly's Basaglar in 2017. The FDA approved Basaglar in December 2015. Another big change in the diabetes class is Express Scripts' exclusion of Novo Nordisk's Victoza for the second year in a row. Victoza is the best-selling GLP-1 treatment.