Express Scripts adopted a more aggressive strategy in its 2019 formulary, excluding products for HIV, multiple sclerosis and Factor VIII, and swapping a key hepatitis C drug with a reportedly less-effective treatment.
According to a Drug Channels blog post, the formulary excluded AbbVie’s Mavyret in favor of Merck’s Zepatier. Mavyret, which carries a low list price, is the “market share leader,” while Zepatier’s price was recently cut, but is unable to treat all types of hep C.
“Consequently, the 2019 preferred formulary will force at least one in four patients to use the products with high list prices and high rebates,” Drug Channels’ Adam Fein writes. “Many patients will end up incurring much higher out-of-pocket costs.”
Below are exclusions and inclusions in key specialty categories, according to the post:
- Exclusion: Extavia
- Inclusions: Avonex, Betaseron, Plegridy, Rebif and Rebif Rebidose
- Exclusion: Atripla
- Inclusions: Biktarvy, Genvoya, Odefsey, Stribild, Symfi, Symfi Lo and Triumeq
Factor VIII recombinant
- Exclusions: Eloctate, Recombinate, Xyntha and Solofuse
- Inclusions: Advate, Adynovate, Afstyla, Helixate Fs, Kogenate FS, Kovaltry, Novoeight and Nuwiq.