Express Scripts added 70 new drug exclusions<\/a> under its National Preferred Formulary bringing their total excluded drugs to 422 out of 3,977. About 14 specialty drugs have been ruled out and 11 drugs are demoted from preferred to non-preferred status.<\/p>\n Diabetes, a major driver for healthcare spending, sees decreased utilization of its type 2 diabetes drugs. Januvia and its combination products will be the only DPP4 inhibitor drugs to be covered resulting in the exclusion of Tradjenta.<\/p>\n The PBM also made notable<\/a> exclusions in specialty categories such as autoimmune disorders, oncology and lipid-lowering therapies.<\/p>\n Under the oncology category, Express Scripts excluded AstraZeneca\u2019s BTK inhibitor Calquence and replaced it with AbbVie\u00a0and Johnson & Johnson\u2019s rival drug Imbruvica. 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.<\/p>\n Express Scripts excluded Novartis\u2019 psoriasis drug Cosentyx, which previously enjoyed<\/a> Tier 2 placement and swapped it with Eli Lilly\u2019s rival Taltz, which was on the PBMs exclusion list in 2020.<\/p>\n Amgen\u2019s Repatha replaced Regeneron\u00a0and Sanofi\u2019s anti-cholesterol drug Praluent. Notably, CVS prefers Praluent and removed Repatha from its formulary. Express Script\u2019s 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\u00a0from $14,000 a year.<\/p>\n <\/p>\n CVS Caremark <\/strong><\/em><\/span><\/p>\n CVS Caremark excluded<\/a> 57 drugs from its standard formulary in 2021 compared to 100 drugs in 2020. The PBM states that only 0.4 percent of members will experience<\/a> any changes in 2021.<\/p>\n CVS also excluded<\/a> drugs from new categories such as acromegaly, oncology, gastrointestinal, ophthalmic, Parkinson\u2019s disease, cardiovascular and so on.<\/p>\n For oncology, CVS Caremark excluded Bortezomib and Kyprolis instead preferring Ninlaro and Velcade. It also excluded, Neulasta but will provide coverage for its biosimilar, Ziextenzo.<\/p>\n Sandostatin LAR Depot, Signifor LAR, and Somavert are excluded while Somatuline Depot was given the preferred status for acromegaly. Out of the three drugs CVS Caremark excluded for 2021, Somavert enjoyed a favorable<\/a> Tier 2 status for 2020.<\/p>\n On the other hand, CVS added back six drugs into its formulary in drug classes such as anticonvulsants, diabetes, growth hormones, ophthalmic and osteoarthritis. Anticonvulsant drug, Lamictal and growth hormone drug, Norditropin previously not covered in 2020 are now back on the formulary.<\/p>\n The PBM\u2019s diabetes test strips category changes are expected to save<\/a> more than 10 percent in 2021. It excluded ACCU-CHEK products which previously enjoyed a favorable Tier 2 placement and newly added Onetouch products with a preferred status.<\/p>\n
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