2018 CVS Caremark Formulary Removes Jardiance in Favor of Invokana

Other household names are among 17 knocked off the formulary

CVS Caremark is knocking 17 medications in 10 classes off its 2018 formulary, FiercePharma reports. The list includes such well-known drugs as empagliflozin (Jardiance, Eli Lilly/Boehringer Ingelheim), ezetimibe (Zetia, Merck), olmesartan medoxomil (Benicar, Daiichi Sankyo), and armodafinil (Nuvigil, Teva Pharmaceutical Industries).

Among the sodium-glucose cotransporter 2 inhibitors used to treat diabetes, the pharmacy benefit manager replaced Jardiance with canagliflozin (Invokana, Johnson & Johnson) as a preferred option. While both drugs posted a 14% composite reduction in cardiovascular risks in their respective outcomes studies, canagliflozin was found to have an increased risk for amputations.

Weighing in on the decision, Bernstein analyst Ronny Gal wrote in a note that it’s “just a price play, we suspect, but shows how fungible these classes have gotten.”

Despite the removals, FiercePharma reports, CVS Caremark expects 99.76% of members will be able to keep using their current treatments.

The formulary is adding 17 new medications as either preferred or nonpreferred treatment options. CVS added a pair of Biogen multiple sclerosis drugs, interferon beta-1a (Avonex) and peginterferon beta-1a (Plegridy), which is “testament to the challenge of excluding MS drugs,” according to Gal. The new formulary also adds Astellas and Pfizer’s prostate cancer drug enzalutamide (Xtandi) as a preferred option.

The changes apply to the CVS Standard Control Formulary and not to its Standard Opt-Out Formulary. CVS noted that the first-quarter per-member-per-month cost for the “control” formulary was $85.90 compared to $121.12 for those with the “opt-out” formulary. The generic dispensing rate was 86.5% in the “control” formulary  versus 83.8% among “opt-out” clients.

The company is still working on formulary management for autoimmune and hepatitis C drugs, with an announcement expected next month for those classes.

In addition to its formulary adds and exclusions, CVS unveiled “transform value” programs that seek to limit costs in three classes to start: cancer, obesity, and chronic obstructive pulmonary disease. Under the programs, if costs pass a certain threshold in each of those areas, the drugmaker would need to “provide additional value” to the PBM and its clients.

Earlier in the week, Express Scripts released its own 2018 formulary, rolling out 64 new exclusions in a variety of therapeutic areas. The company plans to exclude Lilly’s osteoporosis drug Forteo in favor of Tymlos from Radius Pharmaceuticals, and Amgen’s Neupogen in favor of a Novartis biosimilar.

Sources: FiercePharma; August 2, 2017; CVS Caremark; August 1, 2017.