CVS Health (CVS) announced their 2022 formulary changes, both exclusions and additions, stating the focus of their formulary strategy continues to be “providing access to clinically appropriate and cost-effective drugs for plan members at the lowest net cost for our clients.” They expect to deliver $4.4B in client savings while estimating 99.61% of members will not be impacted by the changes. Key considerations related to these formulary changes include:
• Ten of the 20 new exclusions are for specialty medications
• CVS is expanding use of biosimilars as preferred products
• There is expansion of the CVS brand over generic lower net cost strategy
Across the PSG book of business, the 2022 changes are not expected to have a significant impact, affecting only 1% of members and 2% impact on total drug spend.
The most considerable formulary change, in terms of member impact, is Eliquis®.
11.6% of members will be impacted by the exclusion of Aimovig®, the first of a new class of migraine drugs called calcitonin gene-related peptide (CGRP) inhibitors. CGRP inhibitors are the first drugs developed specifically for the prevention of migraines.
Two biosimilars (Nivestym and Retacrit) will become preferred formulary alternatives with the removal of Leukine® and Aranesp®, respectively.
In September 2020 the FDA approved generic Truvada® (emtricitabine-tenofovir disoproxil fumurate), which is used for both the treatment and prevention, PrEP (pre-exposure prophylaxis) of HIV.
CVS’s brand over generic strategy will continue with the removal of two generics: topical ivermectin 1% cream (Soolantra®) and budesonide ER 9mg tablets (Uceris®), covering their brand counterparts on Tier 1 instead.
Cinryze® and Haegarda®, two injectable specialty drugs used to prevent acute attacks of Hereditary Angioedema (HAE), are being excluded leaving two formulary alternatives. One alternative is oral, Orladeyo™, and the other is a subcutaneous injection, Takhzyro®.
Two disease-modifying therapies for the treatment of multiple sclerosis (MS) are being added back to the formulary, Avonex® and Plegridy® after being excluded effective in 2020.
Review PSG’s commentary on the 2022 ESI formulary changes here.