Upcoming 2021 Midyear Express Scripts Formulary Changes



Renee Rayburg, RPh
April 28, 2021

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:

  • Arnuity Ellipta
  • Asmanex HFA & Twisthaler
  • Flovent HFA & Diskus
  • QVAR Redihaler

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:

  • Truvada for both treatment and prevention of human immunodeficiency virus (HIV)
  • Zytiga, an oral oncology drug used in the treatment of prostate cancer
  • Suboxone for the treatment of opioid addiction.

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

  1. Apokyn for Parkinson’s
  2. Northera for low blood pressure caused by certain medical conditions
  3. NovoSevenfor hemophilia patients with inhibitors
  4. Zytiga for prostate cancer

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.



Renee Rayburg helps lead Artemetrx services in Clinical Consulting with more than 30+ years in pharmacy and medical benefit management to support our health plan sponsors, providers, and patients.  Her thought leadership and passion for specialty pharmacy continues to influence the market, including important changes to specialty vendor clinical management products for the betterment of clients.