Under the oncology category, Express Scripts excluded AstraZeneca’s BTK inhibitor Calquence and replaced it with AbbVie and Johnson & Johnson’s rival drug Imbruvica. The PBM also made notable exclusions in specialty categories such as autoimmune disorders, oncology and lipid-lowering therapies. Januvia and its combination products will be the only DPP4 inhibitor drugs to be covered resulting in the exclusion of Tradjenta.

About 14 specialty drugs have been ruled out and 11 drugs are demoted from preferred to non-preferred status.ĭiabetes, a major driver for healthcare spending, sees decreased utilization of its type 2 diabetes drugs. Express Scripts, CVS Caremark and OptumRx, which dominate the PBM market, have excluded dozens of new drugs from their largest formularies for 2021.Įxpress Scripts added 70 new drug exclusions under its National Preferred Formulary bringing their total excluded drugs to 422 out of 3,977. Payers are constantly trying to salvage the financial impact of the COVID-19 pandemic on drug access by leveraging formulary exclusion to achieve deep discounts and provide medication access.

From potential shortages of generic drugs to a brand new COVID-19 pipeline, this pandemic is undoubtedly impacting pharmacy benefits.

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