Express Scripts Says Its Formulary "Exposes Opportunities" to Improve Affordability

Express Scripts framed its formulary as a response to pharma: “Despite promises to limit price increases, drug makers are trying to game the market by delaying generic competition, blocking access to safe and effective biosimilars, and coyly deferring—not cancelling—list price increases,” it said.

Yesterday, pharmacy benefit manager (PBM) Express Scripts released its National Preferred Formulary Exclusion List Changes for 2019, which will provide access to 3886 medications to the 25 million Americans whose plans use the PBM. There will be 48 new exclusions to the formulary, effective January 1, 2019, including antiretrovirals, growth hormones, and hepatitis C treatments.

Express Scripts framed its formulary as a response to pharma: “Despite promises to limit price increases, drug makers are trying to game the market by delaying generic competition, blocking access to safe and effective biosimilars, and coyly deferring—not cancelling—list price increases,” read the PBM’s statement on the formulary changes, saying that its changes “expose opportunities” to improve affordability and access to medications.

Click here to read more about list price increases.

“Countering drug makers’ high prices includes seizing opportunities for generic and biosimilar drugs, forcing head-to-head competition between brand-drug makers and understanding new or updated FDA indications and studies,” said Everett Neville, RPh, executive vice president of strategy, supply chain, and specialty at Express Scripts in a statement.

PBMs have been making news of late as the Trump administration looks to lower out-of-pocket costs for consumers. Many stakeholders have pointed to the often-undisclosed number of rebates that PBMs receive as a main cause for the high cost of drugs, and HHS has signaled that it may do away with the rebate system altogether.

Meanwhile, drug makers have also been the subject of criticism for allegedly taking part in “pay-for-delay” tactics, in which they reach settlements with biosimilar or generic developers to stave off the launch of a lower-cost product for years. Express Scripts took an opportunity to highlight that controversy in announcing its formulary: “Unfortunately, FDA approval is not assured when drug makers abuse the drug approval system and enter into settlements or otherwise delay the launch of lower-cost competitors, including specialty drugs that treat inflammatory conditions. We remain committed to re-evaluating these therapy classes as soon as competitive products come to market,” said Neville.

In addition to its formulary changes, Express Scripts has also stated that it will be passing on approximately 95% of all pharmaceutical purchase discounts, price reductions, and rebates back to its PBM commercial and health plan clients and their members.