2016 formulary exclusions in 9 key areas

August 11, 2015

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