Express Scripts bars 48 drugs for 2019, hitting AbbVie, Gilead, Boehringer and more

Mavyret
AbbVie's Mavyret is among the major drugs excluded from Express Scripts' 2019 preferred formulary. (AbbVie)

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.

On-Demand Webinar

Leveraging A Medical Record-Enriched Patient Dataset for COVID-19 Research

You are invited to join a webinar that will explore the ways researchers can leverage this enriched dataset for important COVID-19 research. Sign up today for this informative webinar to learn how you can leverage one of the only medical record reviews solely using real-world data from hospitalized COVID-19 patients.

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.

RELATED: Express Scripts adds 64 medications to its no-go list, hitting Lilly and Amgen but sparing diabetes

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.

Suggested Articles

Life sciences companies have pivoted quickly during COVID-19 - Syneos Health® is supporting more than 80 active COVID-19 projects, including vaccines.

New York's Covaxx has signed on with three South American nations to provide 140 million doses of its early-stage COVID-19 vaccine.

To get the COVID-19 vaccine out quickly, Pfizer has been running rehearsals at distribution sites, creating "growing confidence," U.S. officials said.