Mylan’s EpiPen and its generic EpiPen became the preferred epinephrine auto-injectors on Express Scripts’ 2018 National Preferred Formulary (NPF)—just one of many controversial decisions in the PBM’s new formulary.
For the 2018 benefit year, Express Scripts made 64 new drug exclusions, including Neupogen (in favor of the biosimlar Zarxio), Trulance for irritable bowel syndrome, as well as the painkillers Opana ER (which was removed from shelves at the FDA’s request early last month) and Oxycodone ER.
“Because of our formulary strategies, employers who use the NPF are expected to save an additional $2.5 billion in 2018,” the PBM said in a statement. In addition, Express Scripts expects to save participating NPF clients and patients $7.4 billion from 2014 through 2018.
In the case of epinephrine auto-injectors, only Mylan’s EpiPen and EpiPen Jr. are approved, while Auvi-Q injectors (made by A-S Medication), Impax, and Lineage are now excluded.
“After an individual panel of experts evaluated all the products in that therapy class, they determined which were efficacious. At that point, we engaged in negotiations with various manufacturers and Mylan offered deeper discounts,” Phil Blando, a spokesman for Express Scripts, told Drug Topics.
Along with prior year exclusions, the total number of excluded drugs is just 159 out of more than 3,791 available drugs.
“The vast majority of patients we serve—99.22% to be exact—will not see any changes to their drug coverage,” Express Scripts said in a statement. “Of course, some patients will be asked to use a different medication that achieves the same health outcome at a lower cost. If any patient has a clinical need that requires a medication that is not on the formulary, we have provided a clear pathway to have that drug covered. Our goal is always to make sure a patient gets the medicine that helps them achieve the best outcome.”
In addition to the exclusions, brand drug manufacturers must, for the first time, provide significant savings to be included on the NPF in 2018 if there are “clinically equivalent, lower cost options available,” Express Scripts said.
“For the 2018 NPF, we focused on high-spend multi-source brand drugs and excluded 46,” the PBM added.