CVS Health Corp.'s pharmacy benefits unit will not cover Merck & Co. Inc.'s cholesterol drug Zetia, Teva Pharmaceutical Industries Ltd.'s stimulant Nuvigil and Daiichi Sankyo Company, Ltd's high blood pressure medicine Benicar in 2018, but added a Pfizer Inc. cancer drug and two Biogen Inc. multiple sclerosis options to its list.
CVS Caremark released its 2018 national preferred formulary, the list of medicines it will cover for the roughly 90 million patients it manages through insurer contracts, the day after Express Scripts Holding Co. released its own excluding 64 drugs.
In total, the CVS unit dropped 17 drugs and added 17 others, 11 in a preferred position, or the first option, and six nonpreferred but still eligible for coverage. It expects the changes to impact less than 1% of its covered patients, according to a statement.
Pfizer and Astellas Pharma Inc.'s prostate cancer treatment Xtandi is a preferred drug for next year, as is GlaxoSmithKline plc's lung disease aid Incruse Ellipta and Allergan plc's glaucoma therapy Lumigan.
It also added two multiple sclerosis drugs from Biogen, Avonex and Plegridy, as nonpreferred options.
For diabetes, CVS dropped Eli Lilly and Co. and Boehringer Ingelheim International Gmbh's Jardiance and Synjardy in favor of Johnson & Johnson's Invokana. AstraZeneca PLC's inhaler Symbicort is also now preferred, knocking Merck's Dulera off the list.
Abstral, a fentanyl-based opioid from Sentynl Therapeutics, is nonpreferred, similar to Express Scripts' decision to drop the drug and several other opioids from its list.
CVS is also planning to limit costs for cancer, obesity and respiratory diseases through outcomes-based benefits program in which it will link reimbursements for pricey drugs to their effectiveness for the patients.
Formulary exclusions, especially from the "big three" of CVS, Express Scripts and UnitedHealth Group Inc.'s OptumRx, can have a significant impact on companies' sales. In Sanofi's recent second-quarter earnings call, CEO and director Olivier Brandicourt cited CVS and OptumRx's exclusion of its diabetes drugs as a key driver in the franchise's 23% U.S. sales drop in the quarter.
Alluding to access barriers for Xtandi on Pfizer's second-quarter earnings call, CEO Ian Read said the drug's sales has mostly been concentrated in Medicare and Medicaid thus far. While total sales were $300.7 million in the quarter and doctor prescriptions reach an all-time high, Pfizer supported a number of patients through an assistance program, Read said. Xtandi had been excluded from CVS' 2017 formulary.
Like Express Scripts, CVS is waiting to finalize its coverage decisions for autoimmune and hepatitis C drugs in September.