With Express Scripts’ recent publication of its “2019 Formulary Exclusion List Changes,” and CVS Health’s version expected around October 1, 2018, the implications of this management tool are now beginning to be known. These lists, which include specific drugs that will no longer be covered on the PBMs’ National Preferred Formulary — have increased in number by nearly 160% since 2014. In 2017, exclusions caused approximately 300,000 patients to “switch their medication.”
Formulary exclusions have implications beyond just the lost revenues resulting from medication switches. Brands that are better positioned compared with their competitors often use the lists as powerful marketing and messaging tools to shape HCP and patient impressions about their broader formulary coverage footprint.
This POV, written by Peter Weissberg — Intouch’s market access expert — discusses the ESI and CVS lists, provides tips to help you understand the relevant facts, and includes scenarios to consider in light of the upcoming changes.