Why Express Scripts Tossed 48 Drugs Off Its Formulary: Miller Explains

For the first time, Express Scripts (ESRX) has excluded a few dozen medicines from its national preferred formulary. The move, which the pharmacy benefits manager says had been signaled to drugmakers, comes in the wake of rising prices for brand-name medications, increasingly narrow formularies elsewhere and greater use of co-pay cards. We spoke with Steven Miller, chief medical officer at the PBM, about the factors behind the process. This is an edited version.. Pharmalot: So you’ve eliminated some drugs from the formulary. To what extent is this a new move? Miller: This year what’s unique is that we have a small number of formulary exclusions. It’s very surgical concerning the drugs we’ve excluded. Typically, most people in the national preferred formulary – and these are people who are represented by mostly commercial clients – have three tier benefits plans. We’re maintaining a three-tier benefit, but also excluding a small number for the first time. Pharmalot: How many exactly? Miller: There are 48 drugs and they represent about 1 percent of the drugs on the formulary. Pharmalot: And how many people are affected by this? Miller: We serve almost 100 million people and there are 30 million who have their benefit on the national preferred formulary. This new change will impact about 2.6 percent (if our math is correct, that works out to roughly 780,000 people). Pharmalot: So how did you make these decisions? Miller: We actually have a process where each year w...
Source: Pharmalot - Category: Pharma Commentators Authors: Source Type: blogs