After months of tough negotiations and pushback from patients and doctors, CVS Health is adding the popular blood thinner Eliquis back to its national preferred formulary. For months, patients had been left with two options—make the switch to Johnson & Johnson's rival blood thinner Xarelto or pay for Eliquis completely out of pocket.
A spokesperson for CVS on Thursday said the company managed to secure lower net costs for patients after negotiations with Eliquis’ manufacturers, Bristol Myers Squibb and Pfizer, leading it to re-add the drug to its formulary effective July 1. The drug was previously not included (PDF) starting Jan. 1 of this year.
“Anti-coagulant therapies are among the non-specialty products where we are seeing the fastest cost increases from drug manufactures and we will continue to push back on unwarranted price increases,” CVS Health's spokesperson said.
As for BMS, the company responded that Eliquis is priced “based on the value it delivers” and that the value of the drug is demonstrated through its favorable safety profile.
“Our list price changes for Eliquis have been consistent with the rate of increase of U.S. healthcare expenditures," BMS' spokesperson said. "The list price of a medicine does not reflect discounts and rebates provided to insurance companies and pharmacy benefit mangers (PBMs), and the price patients pay for medicines varies according to their insurance coverage."
After CVS made the decision to pull Eliquis from its 2022 preferred formulary, patients and others pushed back. For instance, Michael Wong, J.D., founder and executive director of the Physician-Patient Alliance for Health & Safety, wrote that CVS was in effect deciding that all patients prescribed a direct oral anticoagulant should receive J&J's Xarelto. This was despite the fact that none of the patients had a physician-patient relationship with the company. He questioned whether CVS was "illegally practicing medicine."
Meanwhile, some created and signed online petitions to encourage the company to listen to patient concerns.
The act of filling prescriptions with a medication other than the one prescribed without the consent of both the patients and prescribing clinicians is called “non-medical switching," according to BuzzRx. Groups such as the American Heart Association and the American College of Cardiology oppose the practice as it can lead to poor patient outcomes and increased risks.
In January, Eliquis list prices rose 6% compared with the year before to $529 for a one-month supply, according to advocacy organization Patients for Affordable Drugs. During the same period, Xarelto’s price increased by 4.9% to $516 monthly.
This isn’t the first time a CVS Health decision ruffled feathers. In 2017, its formulary left off the world’s best-selling basal insulin Lantus, two cancer treatments and two expensive orphan drugs. The exclusion of Lantus was the largest commercial product ever excluded from a formulary.
The Eliquis reversal comes off the heels of the FTC starting an investigation into six of the largest pharmacy benefit managers in the country, including CVS Caremark. The agency said this month that it had sent compulsory orders to the PBMs, requiring them to submit information and records regarding their business practices.