It’s that time of year again—the time when lead PBM Express Scripts ignites pharma’s ire with a brand-new list (PDF) of formulary exclusions.
This time, Express Scripts barred 48 drugs from its national preferred formulary—22 of which compete against generics, 12 whose rivals use the same active ingredient at a lower net cost, and 11 that bear cheaper brand or biosimilar alternatives.
So who’s feeling the pain this time around? AbbVie, for one, whose pangenotypic hep C hotshot Mavyret was left off the list in favor of rivals from Merck & Co. and Gilead. The AbbVie drug has made waves in the hep C category, stealing share from its competitors and posting major growth numbers for the Illinois pharma.
But Gilead is mourning a couple losses of its own, including one-time hep C superstar Sovaldi and HIV treatment Atripla. On the HIV side, Express Scripts will favor other treatments from the Big Biotech, as well as products from nemesis GlaxoSmithKline and generics maker Mylan, in 2019.
Next-generation blood thinners Pradaxa from Boehringer Ingelheim and Savaysa from Daiichi Sankyo were also pushed out into the cold, leaving market-leaders Eliquis from Pfizer and Bristol-Myers Squibb and Xarelto from Johnson & Johnson more room to to duke it out at the top of the class.
To hear Express Scripts tell it, drugmakers asked for the new round of exclusions with their pricing antics, leaving the PBM no choice but to keep their drugs off the “covered” list.
“Despite promises to limit price increases, drugmakers are trying to game the market by delaying generic competition, blocking access to safe and effective biosimilars, and coyly deferring—not cancelling—list-price increases,” Express Scripts said on its website, referencing a recent Trump-appeasing move from Pfizer.
“This is why our work to expand access and maximize value is more important now than ever,” Express Scripts added.
What it didn’t mention, though, is that refusing to cover pricey new therapies also helps its own bottom line, one fact that’s led pharmas to point the finger at payers in attempts to deflect the public’s drug-pricing criticism.