CVS Health removes 17 drugs from formulary, adds outcomes-based program
- CVS Health on Wednesday put out its standard control formulary for 2018, days after competitor Express Scripts announced its own drug coverage list for next year.
- The pharmacy benefit manager (PBM) claims its management approach will have saved its clients a cumulative $13.4 billion from 2012 through 2018. CVS Health provides coverage to 90 million U.S. lives, making it the largest PBM in the country.
- Last year, CVS made biosimilars preferable over their reference product on its formulary, while this year the PBM expects to expand value-based deals to add further benefit for its customers.
CVS Health made major headlines last year when it opted to include the highly touted, but still very new class of biosimilar products over longer-used reference products.
This year, CVS Health looks set to change the game once again with an outcomes-based management program that will specifically target drugs for breast cancer, non-small cell lung cancer (NSCLC), obesity and chronic obstructive pulmonary disease (COPD).
In each of these cases, manufacturers will have to cover costs over a pre-specified threshold if patients don't reach certain outcomes. For example, manufacturers would required to add value if a patient taking an obesity drug does not meet a minimum level of weight reduction within the initial assessment period.
With COPD, if a certain number of patients progress to triple-combo therapies over other medicines for the condition, the manufacturers would have to show enhanced value for using those therapies.
Outcomes-based strategies have long been talked about as a means to control drug pricing. But there have only been a handful of such agreements put into practice and usually with specific drugmakers for specific products. Famously, Amgen inked a deal with Harvard Pilgrim to reimburse the cost of its PCSK9 inhibitor completely if patients taking the drug have certain heart issues.
CVS Health will remove 17 drugs from the 2018 formulary list across 10 drug classes. The exclusions include Eli Lilly & Co.'s SGLT-2 inhibitor Jardiance (empagliflozin) and the combination therapy Synjardy, both shut out in favor of Johnson & Johnson's SGLT-2 inhibitor Inovakana (canagliflozin).
The PBM is also excluding several beleaguered drugs, such as GlaxoSmithKline's Tanzeum (abliglutide). The British drugmaker announced last week it will restructure its organization to focus on four key areas while getting rid of nearly 30 programs, including Tanzeum. Once flagged as growth driver, the GLP-1 antagonist didn't live up to expectations. Probably for the best — CVS Health is excluding the diabetes drug from its formulary list next year.
The PBM is also excluding Benicar (olmesartan) and its iterations. While the drug is now rapidly losing sales to generic competition, drugmaker Daiichi Sankyo made headlines this week for settling claims about the drug and its side effects.
On the other side of the ledger, the 2018 list will add Pfizer and Astellas' prostate cancer drug Xtandi (enzalutamide) back in. Biogen will also be pleased, as the list adds back in two of its older multiple sclerosis therapies — Avonex and Plegridy.
In a very timely fashion, the PBM is also adding Zubsolv (buprenorphine/naloxone) to the list. The drug is Orexo's opioid dependece treatment. Zubsolv could see an increase in sales as the opioid epidemic continues to worsen across the nation and governments looks for solutions to the problem.
- CVS Health 2018 Formulary
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