This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: Drug Channels Quarterly Update: Patients, Payers, and PBMs.
Click here to see the original post and comments from January 2021.
Once again, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have increased the number of drugs they have excluded from their standard formularies.
Today, I update our annual tracking of the number of exclusions by each PBM. I also highlight the expansion of exclusions into major specialty therapy classes. The 2021 formulary exclusion lists are available below for your downloading pleasure.
Eight years ago, I outlined the inevitability of formulary exclusions. But I didn’t anticipate just how far PBMs would push this tool. Expect much more controversy as exclusions hit previously untouched but sensitive sole-source products in oncology, rheumatology, and beyond—and even start moving into Medicaid.
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