Profusion of exclusions
Key changes expand excluded drug list from Express Scripts formulary
Express Scripts Holding Co.'s 2015 formulary exclusions offer hope that companies can renegotiate once-excluded drugs back into coverage. But the pharmacy benefits manager appears to be expanding the number of drugs and drug classes it scrutinizes.
Express Scripts released its 2015 formulary on Aug. 1. The list adds 10 drug classes and 25 product exclusions for a total of 66 products excluded from the formulary. The changes to the new list suggest new drugs could get excluded for lack of time to negotiate, even if they are priced competitively. And with the PBM continuing to add therapeutic categories to its list, old drugs aren't necessarily safe either (see "Express Scripts Exclusions Update," page 9).
The same week that Express Scripts unveiled its changes, CVS Caremark Corp. notified its clients of new formulary exclusions for 2015. Spokesperson Christine Cramer noted that CVS does not publish its list; however, she did confirm 23 new additions, which bring the total number of product exclusions to 95 (see "CVS Exclusions Update," page 8).
Express Scripts spokesperson David Whitrap said the PBM continues to use the two-step process for evaluating formulary exclusions that it described to BioCentury in 2013. First, a P&T committee judges products for clinical equivalence. Those that