Reprinted from DRUG BENEFIT NEWS, biweekly news and proven
cost management strategies for health plans, PBMs, pharma companies and
employers.
August 7, 2015 Volume
16 Issue 15
CVS Health Corp. and Express Scripts
Holding Co. recently posted their 2016 drug lists, which exclude both specialty
and traditional medications. Both companies claim the cuts generate billions of
dollars in savings, but some industry observers continue to question the true
financial impact to plan sponsors.
Express Scripts on July 31 said its
2016 National Preferred Formulary, which serves 25 million people in the U.S.,
excludes 80 products out of more than 4,000 drugs available on the market. As
in prior years, the company explained that each excluded drug has a clinically
equivalent, lower-cost option available and stressed that its process includes
input from an independent group of physicians who review extensive clinical
data prior to any cost considerations made by the PBM.
Express Scripts projects that the
National Preferred Formulary will save clients approximately $1.3 billion in
2016, for a total of more than $3 billion since the company first excluded 48
products from its 2014 list. Express Scripts added that the changes will impact
less than 0.5% of members using the standard formulary.
CVS, meanwhile, on Aug. 3 unveiled its
2016 standard formulary, which features an additional 26 removals for a total
of 124 excluded products. CVS began making formulary exclusions in late 2011,
when it eliminated 34 drugs from its 2012 standard formulary.
In an Aug. 4 post to the Drug Channels
blog, Pembroke Consulting, Inc. President Adam Fein, Ph.D., pointed out that
despite the savings promised by the PBMs, there’s been no independent
verification of these savings. “By dropping products to gain negotiating
leverage, PBMs get significant marketing advantages with their plan sponsor
clients,” he wrote. “Basically, the PBMs can claim to be standing up to pharma
on behalf of payers, regardless of the actual dollar or patient impact.”
“I feel that it is important for
clients to analyze the costs, savings, and disruption as a result of these
formulary changes,” advises Brian Anderson, a consultant with Milliman. “It is
important for the clients to validate that these changes line up with their
goals for access to care and financial objectives for 2016. The formulary is a
key financial driver, and placement of the new high-cost medications and
biologics during 2016 will influence trends significantly.”
Download the CVS drug list at http://tinyurl.com/pr5h2ky.
View the Express Scripts drug list at http://lab.express-scripts.com.
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