Right on the heels of Express Scripts’ 2018 formulary release, rival PBM giant CVS Caremark has published its list of which drugs are in and which are out.
In the SGLT2 class of meds to treat diabetes, CVS removed Eli Lilly and Boehringer Ingelheim’s Jardiance and added Johnson & Johnson’s Invokana as a preferred option. That’s despite the fact that Invokana came with an increased risk for amputations in a cardiovascular outcomes study finished earlier this year. Both meds posted a 14% composite reduction in CV risks in their respective outcomes studies.
Weighing in on the decision, Bernstein analyst Ronny Gal wrote in a note it’s “just a price play, we suspect, but shows how fungible these classes have gotten.” A Boehringer Ingelheim spokesperson told FiercePharma via email that the company is "very disappointed" with the formulary move "and the potential treatment disruption and impact this could have on patients."
"This decision restricts treatment options for patients who could benefit from Jardiance’s life-saving cardiovascular benefit to reduce the risk of CV death," she added. "While we cannot comment on why CVS made this decision, the positive benefit-risk profile of Jardiance brings critical value to patients and healthcare providers."
All told, CVS removed 17 drugs in 10 classes, with Merck’s Zetia, Daiichi Sankyo’s Benicar and Teva’s Nuvigil among them. Despite the removals, the company expects 99.76% of members will be able to keep using their current treatments.
The formulary also brings on 17 new meds as either preferred or nonpreferred treatment options. CVS added a pair of Biogen multiple sclerosis drugs, Avonex and Plegridy, which is “testament to the challenge of excluding MS drugs,” according to Gal. The new formulary adds Astellas and Pfizer’s prostate cancer drug Xtandi as a preferred option.
The PBM is still working on formulary management for autoimmune and hep C drugs, with an announcement expected next month for those classes.
In addition to the adds and exclusions, CVS unveiled “transform value” programs that seek to limit costs in three classes to start: cancer, obesity and COPD. Under the programs, if costs pass a certain threshold in each of those areas, the drugmaker would need to “provide additional value” to the PBM and its clients.
Earlier this week, Express Scripts released its own 2018 formulary, rolling out 64 new exclusions in a variety of therapeutic areas. The company plans to exclude Lilly’s blockbuster osteoporosis drug Forteo in favor of Tymlos from Radius Pharmaceuticals, and Amgen’s Neupogen in favor of a Novartis biosimilar.
In total, Express Scripts said its formulary management will save $2.5 billion in drug costs next year. CVS expects its management will bring clients $13.4 billion in savings between 2012 and 2018.
Editor's note: This story was updated with a statement from Boehringer Ingelheim.