Express Scripts’ New Formulary Favors Biosimilars, Cuts Opioids

The biosimilar Zarxio is in and the painkillers Opana ER and extended release oxycodone are out on Express Scripts’ 2018 National Preferred Formulary (NPF). These are just two of the changes the PBM made among the 64 new drug exclusions for the 2018 benefit year.

“Because of our formulary strategies, employers who use the NPF are expected to save an additional $2.5 billion in 2018,” Express Scripts said in a statement. From 2014 to 2018, the PBM expects to save participating NPF clients and patients $7.4 billion because of formulary exclusions.

In one of Express Scripts’ more controversial decisions, Mylan’s EpiPen (epinephrine auto-injector) and its generic EpiPen became the preferred epinephrine auto-injectors, while Auvi-Q, Impax, and Lineage autoinjectors are now excluded.

“After an individual panel of experts evaluated all the products in that therapy class, they determined which were efficacious. At that point, we engaged in negotiations with various manufacturers and Mylan offered deeper discounts,” Phil J. Blando, a spokesperson for Express Scripts, told Drug Topics.

In addition, Neupogen was axed in favor of the biosimilars Zarxio (filgrastim-sndz) and Granix (tbo-filgrastim). Trulance (plecanatide)-a top-selling drug for irritable bowel syndrome-was also cut in favor of Amitiza (lubiprostone) and Linzess (linaclotide).

Oxycontin will remain on the formulary, but other long-acting oral opioid analgesics are off. Express Scripts said the deletion of Opana ER is warranted. “Opana is being excluded based on FDA actions,” Blando said. In June, the FDA requested that Endo Pharmaceuticals remove its reformulated Opana ER (oxymorphone hydrochloride) from the market because of its potential for abuse.

Oxycodone ER was cut because “is a very high-cost drug and its manufacturer did not offer meaningful discounts,” Blando said. Preferred alternatives include hydromorphone ER, morphine sulfate ER, ocymorphone ER, Hysingla ER and Nucynta ER.

Up next: AAM weighs in

Express Scripts’ decision to cut out the top-selling drug Neupogen filgrastim in favor of Zarxio and Granix was praised by executives with the Association for Accessible Medicines (AAM), which represents generic and biosimilar drug manufacturers.

“[Express Scripts] decision reflects a clear appetite for the savings and access that biosimilars bring to patients and payers,” Christine M. Simmon, JD, Senior Vice President of Policy and Strategic Alliances for AAM and Executive Director of AAM’s Biosimilars Council, told Drug Topics. “[Express Scripts] is among the many stakeholders that work with AAM’s Biosimilars Council to support regulatory and legislative policies that foster the development of a robust biosimilars marketplace for patients.”

Blando said Trulance was taken off the 2018 formulary because Express Scripts was “able to drive down costs on the existing products with minimal member disruption.”

Related article: Express Scripts Lowers Drug Prices For Some Patients

While some of the exclusions may be subect to debate, Express Scripts said that the total number of excluded drugs is just 159 out of more than 3,791 available drugs.

“The vast majority of patients we serve-99.22% to be exact-will not see any changes to their drug coverage,” Express Scripts said in a statement. “Of course, some patients will be asked to use a different medication that achieves the same health outcome at a lower cost. If any patient has a clinical need that requires a medication that is not on the formulary, we have provided a clear pathway to have that drug covered. Our goal is always to make sure a patient gets the medicine that helps them achieve the best outcome.”

The PBM’s overall philosophy is “to drive value without the need for exclusions,” Blando said. “Exclusions are done to create savings for clients and members. Additionally, there are multiple factors that help to determine formulary decisions including, but not limited to, clinical data and guidelines, available safety information, newly launched brands/generics, utilization, market analysis, and pricing.”