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

CVS Caremark's Woonsocket, RI, headquarters--Courtesy of CVS Caremark

It started in 2011 with just a handful of drugs. CVS Caremark ($CVS) chucked 34 meds off its formulary, partly in a snit over copay coupons, partly just to see what would happen. It was a pilot program, the pharmacy benefits manager (PBM) said. It made a few headlines, but unless you were a patient who had to switch meds or a brand manager with a product kicked off the team, the headlines passed by with not much note.

Now, CVS' excluded list comprises almost 100 drugs and related products. Express Scripts ($ESRX) has added its own 66 exclusions to the mix. The changes aren't just noted. They're analyzed. They have the power to move markets. Just look at what's happened in the past few days.

Companies with drugs newly barred from the PBMs' doors see their stock prices drop--just ask Horizon Pharma ($HZNP), whose combo painkillers Duexis and Vimovo got the boot from Express Scripts last week. Luckier drugmakers with reinstated products--such as GlaxoSmithKline ($GSK) and its Advair respiratory med--feel the boost.

Welcome to the new era of U.S. formulary management, where drugmakers have to wheel and deal like never before to keep a place. Glaxo got Advair back into Express Scripts' graces by offering discounts--fairly hefty discounts, we're told. Glaxo's price breaks also persuaded CVS to nix Advair competitor Symbicort, which had spent the past 6 months using formulary status to steal market share. Read more in FiercePharmaMarketing >>