Express Scripts adds 64 drugs to list of exclusions for 2018; CVS Health replaces Lilly’s diabetes drug with Janssen’s

When Express Scripts released its national preferred formulary for 2018 last week, a few notable names were among the 64 new drugs that will be excluded from coverage. By excluding these drugs and others that were already on Express Scripts’ list, the pharmacy benefit manager (PBM) estimated that it would save $2.5 billion in drug costs next year.

Eli Lilly’s osteoporosis drug Forteo (teriparatide) is one of the drugs that will no longer be covered as of January. Radius Health’s recently approved Tymlos (abaloparatide), which was launched at a substantially discounted list price relative to Forteo’s, is on the 2018 formulary instead. FiercePharma noted that Forteo garnered sales of $1.5 billion last year. 

Amgen’s Neupogen (filgrastrim), a biologic treatment used to increase white blood cell counts in patients undergoing chemotherapy, also appears on the updated list of excluded treatments. Sandoz’s Zarxio (filgrastrim-sndz), the first biosimilar to gain Food and Drug Administration approval, and Teva Pharmaceutical’s biosimilar, Granix (tbo-filgrastim), will take Neupogen’s spot on the formulary. 

As might be expected, the PBM added Kaleo Pharma’s Auvi-Q epinephrine injector to the list of excluded drugs. When Kaleo launched its EpiPen competitor earlier this year, it said it would charge patients with commercial insurance nothing for the product, regardless of whether their insurance plan paid for it, and families with incomes below $100,000 could obtain Auvi-Q free of charge. For patients who don’t qualify for free Auvi-Q injectors but who pay cash, the cost would be just $360. But Auvi-Q’s list price, which is the amount insurers typically pay before discounts and rebates, is $4,500—7.5 times the $600 list price for Mylan’s EpiPen, which will stay on Express Scripts’ formulary for the coming year.

In separate news, CVS Health announced that it was swapping out Lilly’s Jardiance, an SGLT-2 inhibitor used to treat diabetes, for Janssen Pharmaceuticals’ Invokana (canagliflozin), also an SGLT-2 inhibitor, on its 2018 formulary. The FDA recently imposed a black box warning on Invokana regarding an increased risk for amputations, but according to a Medical Marketing & Media article, a CVS Health spokeswoman “downplayed the risk,” noting that it was observed in only one of 12 studies of Invokana and that “data regarding amputations have not been collected systematically in trials of Jardiance.”

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