Earlier this month, CVS Caremark Corp. and Express Scripts Holding Co. released updates to their 2015 formulary exclusion lists. CVS Caremark now excludes nearly 100 products from its Standard Formulary and automatically will leave out new-to-market products, including line extensions and new strengths, until they’ve been reviewed by the PBM’s pharmacy and therapeutics committee. Meanwhile, Express Scripts updated its National Preferred Formulary to exclude 66 products.
While these tactics have so far heard little public opposition from plan sponsors, the National Business Coalition on Health (NBCH) recently issued a brief advising payers to approach the strategy with caution and consider the risks and benefits. NBCH raised a good point, which is that there’s been no independent third-party research to assess the impact on drug costs or larger medical spend. As one industry observer tells DBN, “People on various sides are freaked out about the heavy hand that [Express Scripts] is putting out there….Things are very much in flux; I don’t think anyone has studied this, including the costs of unintended consequences (e.g., Rx abandonment, hospitalization, physician time and frustration, etc.).”
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While these tactics have so far heard little public opposition from plan sponsors, the National Business Coalition on Health (NBCH) recently issued a brief advising payers to approach the strategy with caution and consider the risks and benefits. NBCH raised a good point, which is that there’s been no independent third-party research to assess the impact on drug costs or larger medical spend. As one industry observer tells DBN, “People on various sides are freaked out about the heavy hand that [Express Scripts] is putting out there….Things are very much in flux; I don’t think anyone has studied this, including the costs of unintended consequences (e.g., Rx abandonment, hospitalization, physician time and frustration, etc.).”
continue to read here
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