For 2020, the two largest pharmacy benefit managers (PBMs)—Express Scripts and the Caremark business of CVS Health—have again increased the number of drugs they have excluded from their standard formularies. The 2020 formulary exclusion lists are available below for your downloading pleasure.
Below, I highlight my key takeaways from the 2020 lists:
- The number of exclusions
- Management of specialty drugs
- Indication-based formularies
- The slow adoption of biosimilars
- The PBMs’ patient-unfriendly exclusions in the hepatitis C category
Formulary exclusions have emerged as a powerful tool for PBMs to gain additional negotiating leverage against manufacturers. The prospect of exclusion leads manufacturers to offer deeper rebates to avoid being cut from the formulary. Exclusions are therefore a key factor behind falling brand-name net drug prices.
Read on for a look at this year’s exclusions along with some closing thoughts on what exclusions mean for patients.
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