Express Scripts Formulary Excludes 64 New Drugs

Express Scripts recently announced the 2018 National Preferred Formulary, which excludes 64 new medications in order to improve value-based outcomes.  

The National Preferred Formulary was developed by an independent panel of medical experts, who then made their pharmacy coverage recommendations to Express Scripts. The PBM then worked with pharmaceutical companies to ensure that the medications included in the formulary are cost-effective and clinically appropriate. 

Some noteworthy drugs on the 2018 formulary include Mylan’s controversial EpiPen—while Express Scripts will exclude competitive drugs like Kaleo’s Auvi-Q and A-S Medication’s Adrenalin. 

“For the 2018 benefit year, Express Scripts is making specific changes to drug coverage, with 64 new drug exclusions,” a press release from Express Scripts noted. “Taken together with prior year exclusions, the total number of excluded drugs is just 159 out of more than 3791 available drugs. Because of our formulary strategies, employers who use the National Preferred Formulary are expected to save an additional $2.5 billion in 2018. Collectively, from 2014-2018, Express Scripts expects to save participating National Preferred Formulary clients and patients $7.4 billion because of formulary exclusions.”

Express Scripts expects the exclusion of the 64 new drugs to save about $700 million in 2018.

Price considerations were used to determine the exclusions for 2018. For example, the
decision to include a new osteoporosis medication Tymlos (abaloparatide; Radius) over competitor Forteo (teriparatide; Eli Lilly), which had similar outcomes data, was made after Express Scripts was able to negotiate a lower price for Tymlos. 

Additionally, in some cases biosimilar products were favored over their originator product. In the case of Neupogen (filgrastim; Amgen), the biosimilars Granix (tbo-filgrastim; Teva) and Zarxio (filgrastim-sndz; Sandoz) were included as “preferred alternatives.”

Notable, the National Preferred Formulary did not include new exclusions in the immunology and diabetes sectors, which experts suggested could mean Express Scripts was able to obtain significant discounts in order to allow broader coverage
options.  —David Costill