The battle continues to rage between drug companies that are trying to make as much money as possible and insurers trying to drive down drug prices. CVS Caremark and Express Scripts, the biggest prescription insurers, released their 2017 lists of approved drugs this month, and each also has long lists of excluded medications.
The CVS list also excludes some cancer drugs, along with Proventil and Ventolin, commonly prescribed brands of asthma inhalers, while Express Scripts has dropped Orencia, a drug for rheumatoid arthritis. Such exclusions can take customers by surprise, says Lisa Gill, an editor at Consumer Reports’ “Best Buy Drugs.” “We’ve talked to dozens and dozens of people who find themselves at the pharmacy counter, shocked to find out that the drug is no longer covered,” she tells Shots.
Express Scripts lists 85 and has a policy of not banning cancer drugs or mental health medications. The threat of kicking drugs off their covered lists – which are known as formularies – is a powerful way to drive discounts, says Adam Fein, CEO of the Drug Channels Institute and author of a blog on prescription drug markets.
Both firms claim they’ve already extracted huge savings for their customers: the health insurance companies and private corporations who hire them to manage their prescription drug plans. For 2017, the company has excluded nine drugs that it deems “Hyper-inflationary” – defined as “Products with egregious cost inflation that have readily available, clinically appropriate and more cost-effective alternatives,” says Carolyn Castel, a spokeswoman for CVS Caremark.
For the first time in 2017, it is dropping from its list two so-called biologic drugs – the diabetes drug Lantus and Neupogen, a medicine commonly given to patients undergoing chemotherapy to help boost white blood cells and immunity. The managers of pharmacy benefits pit brand-name drugs that treat the same condition against each other, rather than waiting for generic drugs to come on the market and drive prices down.