CVS Caremark Releases 2018 Formulary Exclusions List


Only 17 drugs removed from CVS Caremark’s 2018 Standard Control formulary.

Formulary lists are an approach used by pharmacy benefit managers (PBMs) to curb unnecessary spending on prescription drugs by covering lower-cost effective drugs opposed to higher-cost competitors.

Yesterday, CVS Caremark released their formulary list for 2018, which is projected to save $13.4 billion for the PBM’s clients, according to a press release. The savings will result from excluding 17 additional drugs, including lower-cost branded drugs, and further transitioning to generics, CVS reported.

Review CVS’ 2017 formulary.

CVS reports that their formulary strategy is centered around maintaining appropriate access to prescription drugs for patients, while reducing overall costs. The PBM reviews all drugs used to treat various conditions to determine if there are more cost-effective alternatives. Experts also review scientific evidence and studies.

Additionally, CVS uses its scale to negotiate lower prices from manufacturers to ensure that out-of-pocket costs are low for patients, according to a press release.

Importantly, most plans include an exception process so patients can access clinically appropriate drugs that are not covered. For 2018, CVS reports that 99.76% of patients will not be affected by the 17 drug removals.

For specialty drugs, CVS reviews all existing products in the class when a new drug is launched to determine appropriate formulary placement and potentially make revisions to the formulary, according to the release. CVS reports that they are still reviewing autoimmune and hepatitis C categories and will provide updates in September 2017.

For 2018, CVS removed:

  • 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
  • Synvisc/Synvisc One

Several drugs were also added back into the formulary for 2018:

Preferred drugs added back:

  • Xtandi
  • Incruse Ellipta
  • Lastacaft
  • Lumigan
  • FML
  • Pred Mild
  • Zubsolv
  • Opsumit
  • Invokana
  • Invokamet/Invokamet XR
  • Symbicort
  • Androgel 1.62%

Non-preferred drugs added back:

  • Avonex
  • Plegridy
  • Abstral
  • Gelnique

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