CVS Health removes 17 drugs as part of its 2018 formulary management strategy

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CVS Health removes 17 drugs as part of its 2018 formulary management strategy

By David Salazar - 08/02/2017

WOONSOCKET, R.I. — CVS Health on Wednesday outlined its plan for formulary management in 2018, which includes the removal of 17 products from its Standard Control Formulary. The move is part of the company’s rigorous approach to formulary management that it began in 2012. Since starting this effort, the company said it will bring $13.4 billion in cumulative savings to its pharmacy benefits manager clients through 2018.

“We remove drugs only when clinically-appropriate, lower-cost (often generic) alternatives are available,” the company said. “Our targeted approach ensures minimum member disruption. For 2018, we estimate 99.76 percent of members will be able to stay on their current therapy. A proactive member and prescriber communication strategy helps members transition to clinically-appropriate medications, minimizing disruption.”

CVS Health said that its Standard Control Formulary, which covers more than 31 million lives, saw a post-rebate per-member-per-month cost of $85.90, compared with $121.12 among patients who are in its Standard Opt-Out Formulary, which doesn’t include formulary removals.

The drugs that the company is removing from the Standard Control Formulary are Doryx/Doryx MPC, Monodox, Follistim, Elelyso, Tanzeum, Sumavel Dosepro, Benicar/Benicar HCT, Effexor XR, Nuvigil, Seroquel XR, Zetia, Horizant, Jardiance, Synjardy/Synjardy XR, Dulera Hyalgan and Synvisc/Synvisc One.

In addition to removing these drugs from the formulary, CVS Health said it also was focused on an outcomes-based approach to management that aligns reimbursement with the value and outcome it delivers. As part of this effort, it is launching a cost cap-based program in three disease states.

The Transform Oncology Value program will focus on breast and non-small cell lung cancers, among others, and hold manufacturers responsible for adding value if a plan’s average cost is above a certain threshold for breast cancer patients.  It also calls for the manufacturer to contribute additional pre-determined value if a non-small cell lung cancer patient progresses to secondary therapy and key lab data has been obtained.

The Transform Obesity Value program, only open to members of the Standard Control Formulary or Advanced Control Formulary, would require additional value from manufacturers if members don’t achieve a minimum level of weight reduction within an initial assessment period. And Transform Respiratory Value program would require enhanced value from manufacturers if a greater number of members being treated for COPD escalate to triple therapy on a certain treatment than others.

The company also said it would be keeping an eye on treatments for autoimmune diseases, which is seeing a boom and this needs constant re-evaluation based on utilization and price.

“Consistent with our policy, as a new specialty product launches all existing products in the class will be re-evaluated to determine appropriate formulary placement and potentially removed or added to formulary,” CVS Health said that new entrants are expected in the hepatitis C class.

The company said its changes for autoimmune disorders and hepatitis C would be shared in mid— September.