![]() Out of the three drugs CVS Caremark excluded for 2021, Somavert enjoyed a favorable Tier 2 status for 2020. Sandostatin LAR Depot, Signifor LAR, and Somavert are excluded while Somatuline Depot was given the preferred status for acromegaly. It also excluded, Neulasta but will provide coverage for its biosimilar, Ziextenzo. The PBM states that only 0.4 percent of members will experience any changes in 2021.ĬVS also excluded drugs from new categories such as acromegaly, oncology, gastrointestinal, ophthalmic, Parkinson’s disease, cardiovascular and so on.įor oncology, CVS Caremark excluded Bortezomib and Kyprolis instead preferring Ninlaro and Velcade. ![]() Express Script’s opposite decision indicates that both players are now going single-source, resulting in a significant drop in price point for PCSK9 inhibitors to $3,000 from $14,000 a year.ĬVS Caremark excluded 57 drugs from its standard formulary in 2021 compared to 100 drugs in 2020. Notably, CVS prefers Praluent and removed Repatha from its formulary. The PBM further incorporated lower-cost generics as preferred agents for 53 of the 70 drug exclusions swapping biosimilars for cancer drugs such as Fulphila and Ziextenzo, with Neulasta.Įxpress Scripts excluded Novartis’ psoriasis drug Cosentyx, which previously enjoyed Tier 2 placement and swapped it with Eli Lilly’s rival Taltz, which was on the PBMs exclusion list in 2020.Īmgen’s Repatha replaced Regeneron and Sanofi’s anti-cholesterol drug Praluent. Under the oncology category, Express Scripts excluded AstraZeneca’s BTK inhibitor Calquence and replaced it with AbbVie and Johnson & Johnson’s rival drug Imbruvica. The PBM also made notable exclusions in specialty categories such as autoimmune disorders, oncology and lipid-lowering therapies. Januvia and its combination products will be the only DPP4 inhibitor drugs to be covered resulting in the exclusion of Tradjenta. About 14 specialty drugs have been ruled out and 11 drugs are demoted from preferred to non-preferred status.ĭiabetes, a major driver for healthcare spending, sees decreased utilization of its type 2 diabetes drugs. Express Scripts, CVS Caremark and OptumRx, which dominate the PBM market, have excluded dozens of new drugs from their largest formularies for 2021.Įxpress Scripts added 70 new drug exclusions under its National Preferred Formulary bringing their total excluded drugs to 422 out of 3,977. ![]() Payers are constantly trying to salvage the financial impact of the COVID-19 pandemic on drug access by leveraging formulary exclusion to achieve deep discounts and provide medication access. ![]() From potential shortages of generic drugs to a brand new COVID-19 pipeline, this pandemic is undoubtedly impacting pharmacy benefits. ![]()
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