Express Scripts has announced its formulary changes effective July 1, 2021. These changes result from their constant evaluation of the clinical and economic value of their formulary offerings. These midyear exclusions include 31 drugs (four are specialty drugs) from both the National Preferred Formulary (NPF) and the National Preferred Flex Formulary (Flex Formulary).
According to Express Scripts, 99 percent of members will not see any changes due to these new exclusions. Plan sponsors have been notified of the changes, and affected members required to switch drug therapies will receive personalized notifications.
Across our Book of Business for plan sponsors with Express Scripts as their pharmacy benefit manager (PBM), we found 0.6 percent of members will be impacted by these formulary changes. The changes will impact 0.8 percent of total drug spend.
The largest member impact will be the exclusion of Pulmicort Flexhaler, an inhaled corticosteroid that is used to prevent asthma attacks. Formulary alternatives will include:
All alternatives offer a different inhaled corticosteroid, but result in similar clinical effectiveness.
Nine brand drugs with U.S. Food and Drug Administration (FDA) approved generic equivalents will be removed, making their generics the preferred products. The brand drugs include:
The generic replacements are determined to be clinically equivalent and offer significant discounts in cost, which will lower costs for both the plan sponsors and members.
Specialty Drug Exclusions
Utilization was only found for Northera and Zytiga in our Book of Business, with 0.4 percent of members affected. The generic equivalents will be the formulary alternative for both drugs.
The pharmacy landscape is everchanging, with new drug approvals, new generic approvals, drug entrance to and exits from the market. The midyear exclusions allow PBMs like Express Scripts to better manage their drug formularies and contain costs. Communication early and often bringing member awareness is the best way to minimize member disruption.