2023 Formulary Changes: CVS Health



Dwight Davis, PharmD
October 11, 2022

Get the Full Analysis of the Big 3 Formulary Changes:

 


 

The following is an assessment of CVS Health’s recently announced formulary changes effective 1/1/2023. This year, the company announced the removal of 23 drugs and added 6 drugs back to its Standard Control Formulary. Of the 23 exclusions, 12 are specialty products, and the remaining drugs are non-specialty.

PSG assessed the impact of these changes across our book of business and prepared the following table. Member impact is measured based on the percentage of members from the given PBM currently utilizing one of the newly excluded medications.

 


 

Excluded Drugs

 

Based on PSG’s book of business analysis, the asthma/steroid inhalant category was the one where we observed the highest potential member disruption, as  81% of total members disrupted by the formulary changes are utilizing one of these excluded medications.

 

Flovent HFA (fluticasone) and Pulmicort Flexhaler (budesonide) are currently preferred products and are clinically similar in the maintenance treatment of asthma and chronic obstructive pulmonary disease (COPD). The three products being excluded are Arnuity Ellipta (fluticasone), Flovent Diskus (fluticasone), and QVAR Redihaler (beclomethasone), which may represent member impact from a prescription volume perspective but offer no clinical advantages over the preferred alternatives.

Other notable exclusions which may represent incremental cost savings for both plan sponsors and patients are as follows:

  • Idiopathic Pulmonary Fibrosis (IPF) Agents – Both the brand tablet and capsule formulations of Esbriet (pirfenidone), a specialty drug used for the treatment of idiopathic pulmonary fibrosis (IPF), will be excluded from the formulary in 2023. The tablet formulation is now available generically and will serve as the alternative. Although utilization of Esbriet for most plans is relatively low, a generic option for a high-cost drug, such as Esbriet, offers the opportunity for cost savings
  • Multi-Source Brand Specialty Drugs – In addition to Esbriet (pirfenidone) noted above, the following multi-source brand specialty drugs are added to the exclusion list for 1/1/2023, with their equivalent generics serving as preferred alternatives. Generic equivalents of these branded agents result in lower out-of-pocket costs to patients and savings to payers. Since these are specialty drugs, any prior authorization requirements for the brand drugs will remain in place for the generic alternatives. No prior use exceptions or grandfathering are available for these multi-source brands. However, prior use exceptions apply to other specialty drug exclusions that do not have generic alternatives.

 


 

Drugs Added Back to the Formulary

Thirteen drugs will be added to the Standard Control Formulary effective 1/1/23, some of which had previously been on the formulary but removed. Four of the six drugs added back to the formulary are specialty drugs. Some drugs will expand already crowded therapeutic categories, such as Ilumya in the anti-inflammatory category. Other additions, such as Alprolix, offer therapeutic advantages.

 

Specialty Drugs Added Back to the Formulary

Aimovig (erenumab-aooe) is a notable drug added back to the formulary. This non-specialty drug is a calcitonin gene-related peptide (CGRP) antagonist and is an injected treatment for the prevention of migraine headaches. The addition of Aimovig will expand the migraine category as two other injectable CGRP antagonists,  Ajovy (fremanezumab) and Emgality (galcanezumab), are currently on the formulary. All three agents have comparable clinical value in preventing migraine headaches and have experienced skyrocketing growth since being introduced to the market.

 

New-to-Market Drugs Additions

After further review, 7 drugs that were part of the new-to-market drug block strategy will be added to the formulary, of which 5 are specialty drugs. The most notable additions are summarized in the table below:

 

Generic Drugs Additions

Three generic drugs added back to the formulary were previously on the Tier 1 Strategy, where the coverage of the brand drug was offered at a generic copay. Now, the brands will be excluded, and members will be switched to the generic equivalents at the generic copay. This shift may represent a significant change for members as these products are widely used and may create some disruption. These generic drugs and their brand-name counterparts are listed in the table below.