Infographic: Do Formulary Drug Exclusions Save Money as Promised?

Laura Joszt, MA
Laura Joszt, MA

Laura is the editorial director of The American Journal of Managed Care® (AJMC®) and all its brands, including The American Journal of Accountable Care®, Evidence-Based Oncology™, and The Center for Biosimilars®. She has been working on AJMC® since 2014 and has been with AJMC®'s parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.

Researchers from Tufts Medical Center analyzed findings from 26 studies to determine how drug exclusion policies affect patients and healthcare costs.

At the beginning of August, Express Scripts and CVS Health announced formulary exclusions aimed at battling rising prescription drug prices. Notably, diabetes drugs took a hit with Express Scripts choosing not to cover Victoza and CVS Health announcing is would pull Lantus, along with its successor Toujeo, in favor of the biosimilar Basaglar.

Researchers from Tufts Medical Center analyzed findings from 26 studies to determine how drug exclusion policies affect patients and healthcare costs. They found that in most cases, exclusion policies work.

However, while most studies suggested that drug exclusions save money, in some cases savings from less expensive alternatives were offset by other healthcare spending, such as increased office visits or hospitalizations.

Read the full study.