Express Scripts plans 'Flex' formulary focused on authorized generics
- Express Scripts said Wednesday it's rolling out a new formulary aimed at giving will employers and health plans a way to cover lower priced products and reduce reliance on rebates for brand-name medicines.
- Authorized alternatives for Gilead Sciences' hepatitis C treatments Epclusa and Harvoni, sold through its Asegua Therapeutics subsidiary, will be the first drugs available on the National Preferred Flex Formulary, which kicks off Jan. 1. Express Scripts said it will add to the formulary as more manufacturers introduce authorized alternatives.
- The move gives Express Scripts clients the option to immediately choose the cheaper option or the brand-name medicine, which may offer them a rebate. Branded products will remain on other formularies, Express Scripts said.
The new formulary arrives as drugmakers and pharmacy benefit managers (PBMs) face increasing pressure to lower the costs of medicines. President Donald Trump has often targeted the drug industry, and his administration has shown interest in curbing rebates that dominate the marketplace and changing safe- harbor protections for PBMs against anti-kickback lawsuits.
When Gilead announced plans in September to launch generic versions of Epclusa (sofosbuvir/velpatasvir and Harvoni (ledipasvir/sofosbuvir), the company said it was responding to a need to bring the lower costs directly to patients. The structure of the healthcare system, government pricing policies and existing contracts make it difficult to quickly lower the list price of a brand-name medicine, the company said at the time.
Express Scripts acknowledged that reality in announcing the Flex formulary.
"Immediate list price decreases for products already on the market can pose challenges for employers and health plans that already have underwritten plan offerings and benefit designs for upcoming years based on existing economics," the PBM said.
Express Scripts' Chief Medical Officer Steve Miller further explained its new formulary will "give cash-paying patients immediate access to more affordable medicine in a way that will not destabilize the drug supply chain."
The generic versions of Epclusa and Harvoni will cost $24,000 for the usual course of therapy, Gilead said in September. The company said the generics could save Medicare Part D patients as much as $2,500 in out-of-pocket costs.
Gilead had seen sales fall for both Harvoni and Epclusa amid increased competition and fewer patients needing treatment after being cured of their disease. Moving to authorized generics was a way to shore up its share of the market.