Express Scripts’ 2019 Formulary Exclusions
Express Scripts’ 2019 National Preferred Formulary excludes certain blockbuster drugs. It also removes new categories of medications that the PBM had shied away from excluding in the past.
The annual list of excluded medications encompasses 48 new medications, including the anticoagulant dabigatran (Pradaxa), the hepatitis C medication sofosbuvir (Sovaldi), and the HIV antiviral combo drug efavirenz/emtricitabine/tenofovir disoproxil fumarate (Atripla).
New therapy areas with excluded drugs include hemophilia, HIV, and hereditary angioedema.
“The reasons for the exclusions are likely multifactorial. One reason could be changes in cost, but it may also be due to the increased competition within the class,” Jeremy Schafer, PharmD, senior vice president at Precision for Value, tells Drug Topics.
Schafer is concerned about the exclusion of drugs for rare diseases, such as hemophilic factor (Xyntha) for hemophilia A, and C1 esterase inhibitor (Berinert) for hereditary angioedema. “Patients may be started on these products in the hospital and then discharged home. Will the patient be stopped by an exclusion and have a delay in therapy as the doctor files for a prior authorization or considers an alternative?”
However, Express Scripts says formulary preference is given to high-value therapies with the lowest net cost for clients, achieved through low list price, rebate or both. For example, efavirenz/lamivudine/ tenofovir disoproxil fumarate (Symfi, and Symfi Lo) are preferred to treat HIV-1. Those medications have 40% lower list prices than Atripla.
Meanwhile, CVS Health will likely announce its 2019 formulary changes in early October. It is expected to exclude 23 drugs, and add four.
CVS MinuteClinic Adds Video Visits
CVS Health’s MinuteClinic recently launched Video Visits, which will provide patients with access to healthcare services 24 hours a day from their mobile devices.
MinuteClinic partnered with Teladoc to offer Video Visits, which are initiated through the CVS Pharmacy app. “Patients who opt to seek care through a fully customized MinuteClinic Video Visit experience the same high-quality, evidence-based care they receive at traditional MinuteClinic locations inside select CVS Pharmacy and Target stores,” CVS Health says.
The Telehealth service is for patients with minor illnesses and injuries. MinuteClinic charges $59 for the visits, and will add insurance coverage over the next few months.
The service is available in nine states—Arizona, California, Florida, Idaho, Maine, Maryland, Mississippi, New Hampshire, and Virginia—and Washington, DC. CVS Health expects Video Visits to be available nationwide, where allowed, by the end of this year.