PBMs Create a Path for Me-Too Drugs, Biosimilars on Their Oncology Formulary
Pharmacy benefit managers (PBMs) and large employer organizations are taking measures to save healthcare costs in 2017, and for PBMs, formulary exclusions is a fool-proof tactic.
“A key to containing cost is effective formulary management,” says a release by one of the bigger pharmacy benefit mangers (PBMs) in the nation, CVS Health, which, along with Express Scripts released their 2017 formulary. The latter announced that it was excluding 85 medicines from its national formulary, with projected cost savings of $1.8 billion in 2017, about 28% more than the current year. CVS has added 35 medicines to its exclusion list—including a few anticancer agents and drugs for diabetes—bumping their exclusion list up to 131.
Come 2017, nilotinib (Tasigna), imatinib (Gleevec), enzalutamide (Xtandi), and filgrastim (Neupogen) will no longer be on the preferred drug list for CVS—they will be replaced by lower cost generic versions or biosimilars. “In situations where the medications are equivalent, from a medical point of view it makes sense to do this in order to reduce cost,” Troyen Brennan, chief medical officer of CVS,
PBM’s, meanwhile, have received flak for not being more upfront and transparent about the drug price rebates that they negotiate with manufacturers, and sharing the savings with employers or clients. This has prompted large employers, such as Macy’s, Coca-Cola, and American Express to
“The PBMs play a labeling game,” said Linda Cahn, a healthcare attorney who works with health plans, when speaking with
Going back to the formulary exclusions, they apply only to new patients, particularly in oncology—those already on an excluded medication can continue to have access to their prescribed treatment.
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