Express Scripts Introduces Flex Formulary for Coverage of Lower Cost Drugs

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The new formulary will allow health plans to cover lower list price products, such as new authorized alternatives to brand-name medications.

Express Scripts announced the impending launch of a novel formulary designed to ease out-of-pocket cost burden for members by allowing health plans to cover lower list price drug products, according to a company press release

The National Preferred Flex Formulary, announced by the pharmacy benefit manager (PBM) this week, seeks to pave the way for coverage of lower list price drugs, such as new authorized alternatives to pricey brand name products. The novel formulary is designed to mirror Express Scripts’ National Preferred Formulary (NPF), covering more than 3800 brand and generic products.

According to Express Scripts, introducing authorized alternative products through a new or additional National Drug Code with a lower list price will create a competitive dynamic similar to a generic coming to market. Employers and health plans can either choose to cover the lower-priced option or the original brand name product, which may have a rebate.

“Some manufacturers have already followed our lead to create a pathway to help close the ‘gross-to-net bubble,’ and give cash-paying patients immediate access to more affordable medicine in a way that will not destabilize the drug supply chain,” Steve Miller, MD, chief medical officer, Express Scripts, said in a statement. “Our new National Preferred Flex Formulary demonstrates our flexibility to keep clients ahead of industry trends, so that they can fully leverage new opportunities to lower their prescription drug costs.”

In August, Express Scripts released its 2019 national preferred formulary. The PBM excluded 48 drugs from the NPF, of which 22 have low-cost generic alternatives, 12 have branded competition with drugs that have the same active ingredient but with a lower net cost, 11 specialty drugs with lower-cost or biosimilar alternatives, and 9 short-term treatments, such as topical creams and ophthalmic treatments.

Authorized alternatives to costly hepatitis C treatments Epclusa (sofosbuvir/velpatasvir) and Harvoni (ledipasvir/sofosbuvir) will be among the first products to be available through the new formulary, according to the press release.

When a lower-cost authorized alternative to a branded medication enters the market, the PBM will evaluate the product for placement on the Flex Formulary, either with preferred or possible non-preferred status. If added, the innovator brand name product and potentially other products in the therapy class will be excluded from coverage.

“Over time, plans, pharmacies and others in the supply chain can transition to a new pricing model and the drug maker could ultimately retire their high list price product,” Express Scripts stated.

The new National Preferred Flex Formulary will be available January 1, 2019.

Reference

Express Scripts Introduces Novel Formulary Built for Evolution of Drug Pricing [news release]. Express Scripts’ website. https://expressscriptsholdingco.gcs-web.com/news-releases/news-release-details/express-scripts-introduces-novel-formulary-built-evolution-drug. Accessed November 13, 2018.

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