Reuters Health Information: Express Scripts plans to narrow specialty drugs list further
Express Scripts plans to narrow specialty drugs list further
Last Updated: 2014-07-30
By Bill Berkrot
(Reuters) - Express Scripts Holding, the largest U.S.
pharmacy benefit manager, expects to exclude more expensive
specialty drugs from its list of preferred medicines next year,
the latest salvo in its campaign to push drugmakers to rein in
Express Scripts said it will announce its preferred drug
list for 2015 in the very near future, with expensive cancer and
hepatitis drugs seen as likely to come under increasing
For 2014, it excluded certain specialty drugs from five
therapeutic categories, including multiple sclerosis and
inflammatory diseases. It has since been a vocal critic of the
$84,000 cost of Sovaldi, the hepatitis C treatment introduced in
December by Gilead Sciences Inc.
"We always have to make sure that we have available for our
patients the products that they need for their treatment,"
Express Scripts Chief Medical Officer Steve Miller said in a
telephone interview. "But we have been unabashed in saying that
we will move market share to the product at which we get the
best clinical outcome at the best price."
Pharmacy benefit managers, or PBMs, administer drug benefits
for employers and health plans and run large mail order
Express, which has nearly 25 million Americans on its
National Preferred Formulary, can drive enormous revenue toward
drugmakers whose products it selects. They will typically be
those that offer lower prices a for similar clinical benefit and
for which patients will be charged lower co-pays.
Miller said Express Scripts impacted market share in sales
of drugs for diabetes and asthma last year. It excluded
GlaxoSmithKline's asthma drug Advair and Novo Nordisk's diabetes
drug Victoza from the formulary, driving business toward
AstraZeneca drugs, such as Symbicort and Byetta.
Doctors prefer a wide variety of medicines at their disposal
as patients can react differently to some drugs. But if a doctor
wants a patient on an Express Scripts plan to use excluded
rheumatoid arthritis drugs, such as Johnson & Johnson's Simponi
or Pfizer Inc's Xeljanz, it must be appealed on a case-by-case
basis. Express's preferred RA drugs are AbbVie's top-selling
Humira and Amgen's blockbuster Enbrel.
Miller said there are greater opportunities to narrow
formularies than ever before due to far more choices within
"We're now seeing a lot of competition across specialty
drugs, even across oncology drugs. Look out for us to continue
to narrow other classes," Miller said.
However, if the potential cost savings is not significant,
"no one wants to disrupt patients for pennies," he added.
Express Scripts has Sovaldi on its formulary as it is the
only available oral medicine with a cure rate above 90% and
minimal side effects for the liver destroying virus. Competing
hepatitis C treatments expected to hit the market in coming
months are being developed by Merck & Co, AbbVie and
Bristol-Meyers Squibb Co.
Sovaldi has racked up nearly $6 billion in sales in its
first two quarters on the market, shattering industry records
for a new medicine.
"We are excited for competition to get into the market
place," Miller said. "The more crowded a market becomes, the
more people have to consider price as a lever."