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 prices.

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 scrutiny.

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 pharmacies.

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 therapeutic categories.

"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."