2016 formulary exclusions in 9 key areas
CVS/Caremark and Express Scripts, the two biggest players in the pharmacy benefits management industry, have both added medications to their exclusion lists.
CVS/Caremark recently made news with the announcement that next year it would not provide insurance coverage for the popular drug Viagra. CVS/Caremark and Express Scripts, the two biggest players in the pharmacy benefits management industry, have both added medications to their exclusion lists.
CVS/Caremark will exclude an additional 31 prescription medications in 2016, while Express Scripts will stop providing insurance coverage for an additional 20 medicines.
Follow the links below to see which obesity, cardiovascular, dermatology, diabetes, gastrointestinal, hepatitis, inflammatory, respiratory, and urologic drugs are on the formulary exclusion lists of CVS/Caremark and Express Scripts.
Anti-obesity
Express Scripts
Excluded: Qsymia
Alternative: phentermine
CVS/Caremark
Excluded: Qsymia
Alternatives: Belviq, Contrave, Saxenda
Cardiovascular
Express Scripts
Excluded: Edarbi/Edarbyclor, Teveten HCT
Alternatives: candesartan/HCTZ, irbesartan/HCTZ,
losartan/HCTZ, valsartan/HCTZ, Benicar/HCT
CVS/Caremark
Excluded: Tricor
Alternatives: fenofibrate, fenofibric acid
Excluded: Advicor, Altoprev, Lescol XL, Lipitor, Liptruzet, Livalo
Alternatives: atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, Crestor, Simcor, Vytorin
Dermatology
Express Scripts
Excluded: Doxycycline 40 mg capsules
Alternative: Oracea
Excluded: BenzaClin Gel Pump, Veltin
Alternatives: clindamycin/benzoyl peroxide, clindamycin
PLUS tretinoin, Acanya, Onexton, Ziana
Excluded: Fluorouracil 0.5% cream
Alternatives: imiquimod 5% cream, Carac
CVS/Caremark
Excluded: clobetasol spray, Clobex spray, Olux-E
Alternative: clobetasol form
Excluded: Apexicon E
Alternatives: desoximetasone, fluocinonide
Excluded: Noritate
Alternatives: metronidazole, sulfacetamide-sulfur, Finacea, Soolantra
Excluded: fluorouracil cream 0.5%, Carac
Alternatives: fluorouracil cream 5%, fluorouracil soln, imiquimod, Picato, Zyclara
Diabetes
(Does not include blood glucose meters or testing strips)
Express Scripts
Excluded: Nesina, Onglyza
Alternatives: Januvia, Tradjenta
Excluded: Kazano, Kombiglyze XR
Alternatives: Janumet, Janumet XR, Jentadueto
Excluded: Tanzeum, Victoza
Alternatives: Bydureon, Byetta, Trulicity
Excluded: Novolin
Alternative: Humulin
Excluded: Apidra, NovoLog
Alternative: Humalog
CVS/Caremark
Excluded: Fortamet, Glumetza, Riomet
Alternatives: metformin, metformin ext-rel
Excluded: Nesina, Onglyza
Alternatives: Januvia, Tradjenta
Excluded: Kazano, Kombiglyze XR, Oseni
Alternatives: Janumet, Janumet XR, Jentadueto
Excluded: Bydureon, Byetta
Alternatives: Trulicity, Victoza
Excluded: Invokana
Alternatives: Farxiga, Jardiance
Excluded: Invokamet
Alternative: Xigduo XR
Excluded: Actos
Alternative: pioglitazone
Excluded: Apidra, Humalog
Alternative: Novolog
Excluded: Humalog Mix 50/50
Alternative: Novolog Mix 70/30
Excluded: Humalog Mix 75/25
Alternative: Novolog Mix 70/30
Excluded: Humulin 70/30
Alternative: Novolin 70/30
Excluded: Humulin N
Alternative: Novolin N
Excluded: Humulin R
Alternative: Novolin R
Gastrointestinal
Express Scripts
Excluded: Duexis
Alternative: famotidine PLUS ibuprofen
Excluded: Vimovo
Alternative: omeprazole PLUS naproxen
Excluded: Asacol HD, Delzicol, Dipentum
Alternatives: balsalazide disodium, Apriso, Lialda, Pentasa
Excluded: Pancreaze, Pertzye, Ultresa
Alternatives: pancrelipase, Creon, Zenpep
CVS/Caremark
Excluded: Amitiza
Alternative: Linzess
Excluded: Relistor
Alternative: Movantik
Excluded: Prevacid, Protonix
Alternatives: lansoprazole, omeprazole, omeprazole-sodium bicarbonate capsule, pantoprazole, Dexilant, Nexium
Hepatitis
Express Scripts
Excluded: RibaPak, RibaTab
Alternatives: ribavirin capsules, ribavirin tablets, Moderiba
Excluded: Harvoni, Olysio, Sovaldi
Alternative: Viekira Pak
CVS/Caremark
Excluded: Viekira Pak
Alternative: Harvoni
Inflammatory
Express Scripts
Excluded: Cimzia, Simponi 50 mg, Xeljanz
Alternatives: Cosentyx, Enbrel, Humira, Simponi 100 MG
(for ulcerative colitis only), Stelara
CVS/Caremark
Excluded: Rayos
Alternatives: dexamethasone, methylprednisone, prednisone
Excluded: Arthrotec, Duexis, Vimovo
Alternatives: celecoxib, diclofenac, meloxicam, or naproxen WITH lansoprazole, omeprazole, omeprazole-sodium bicarbonate capsule, pantoprazole, Dexilant or Nexium
Excluded: Pennsaid
Alternatives: diclofenac, diclofenac sodium solution, meloxicam, naproxen, Voltaren Gel
Excluded: Naprelan
Alternatives: celecoxib, diclofenac, meloxicam, naproxen
Respiratory
Express Scripts
Excluded: Alvesco, Arnuity Ellipta, Flovent Diskus/HFA
Alternatives: Asmanex HFA/Twisthaler, Pulmicort Flexhaler,
QVAR
Excluded: Proventil HFA, Xopenex HFA
Alternatives: ProAir HFA/RespiClick, Ventolin HFA
CVS/Caremark
Excluded: Proventil HFA, Ventolin HFA, Xopenex HFA
Alternative: ProAir HFA
Excluded: Aerospan, Alvesco
Alternatives: Asmanex, Flovent, Pulmicort, Flexhaler, QVAR
Excluded: Symbicort
Alternatives: Advair, Dulera
Excluded: Incruse Ellipta, Tudorza
Alternative: Spiriva
Urologic
Express Scripts
Excluded: Levitra, Staxyn, Stendra
Alternatives: Cialis, Viagra
CVS/Caremark
Excluded: Viagra, Levitra
Alternative: Cialis
