CVS creates one-on-one diabetes rivalries with new formulary exclusions

Express Scripts ($ESRX) wasn't alone in kicking more drugs off its preferred formulary. CVS Health ($CVS) did the same--and though a couple of the changes echoed those of its chief PBM rival's, others showed how the payers are pitting drugmakers against one another for coverage.

The winners? Eli Lilly ($LLY), for one. AstraZeneca ($AZN) won a couple and lost one. Allergan ($AGN) scored, too. Biogen ($BIIB), on the other hand, lost out, with its new multiple sclerosis med Plegridy and older Avonex both losing slots on the preferred list.

Unlike Express Scripts, which announced its new formulary with a blog post, CVS rolled out the changes in the usual way--to its customers. The lists quickly made their way online, however. Here's how the changes stacked up.

In a high-profile brand move, CVS nixed Pfizer's ($PFE) erectile dysfunction med Viagra, giving Lilly's Cialis an exclusive on its standard formulary. Bayer's Levitra was already excluded.

Lilly's other win came in diabetes, where CVS gave the heave-ho to a few drugs, creating one-on-one rivalries in two different classes. Lilly's new long-acting GLP-1 drug Trulicity elbowed aside AstraZeneca's long-acting Bydureon. That puts Novo Nordisk's ($NVO) Victoza and Trulicity in line to compete head-to-head for CVS patients.

CVS' other diabetes victims were Johnson & Johnson's ($JNJ) SGLT2 inhibitor Invokana and its sister combo med Invokamet, leaving AstraZeneca's Farxiga, and Boehringer Ingelheim and Eli Lilly's Jardiance to fight it out in the single-agent area. And now, AstraZeneca has the SGLT2 combo field to itself with Xigduo.

The pharmacy benefits manager also granted some exclusives in the hotly contested gastrointestinal field, with its raft of new meds. For instance, it kicked off Salix's Relistor, one in a new wave of drugs for opioid-induced constipation, in favor of AstraZeneca's Movantik, which Daiichi Sankyo signed on to co-market earlier this year. And it rejected Amitiza, a chronic constipation med marketed by Takeda, for its Allergan-marketed competitor Linzess.

A raft of other exclusions involved drugs cast aside in favor of their new generic rivals. Novartis ($NVS) blood-pressure med Diovan, for instance, as well as Eli Lilly's antidepressant Cymbalta and Bristol-Myers Squibb ($BMY) and Otsuka's Abilify pill.

The reason for the latter changes is obvious: Cheap copycats always get the jump on their brand-name counterparts. The other moves? CVS hasn't said, and the drugmakers won't talk specifics on their negotiating tactics. But given the pricing environment these days--and the intensifying competition in some fields, like diabetes--it's certain that drugmakers didn't gain or lose without dollar signs coming into play.

- check out the CVS formulary

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The formularies are here! Brace yourselves for the 48 new exclusions