31 Drugs, Including Viagra, Will Be Cut From CVS’s Formulary
By: Reuters (NY Times) August 2015
CVS Health, which operates the nation’s second-biggest pharmacy benefit manager, CVS Caremark, will exclude an additional 31 prescription medicines from insurance coverage next year, including Viagra and widely used treatments for diabetes and multiple sclerosis.
Released this week, the list of excluded drugs also included the weight-loss treatment Qsymia, which last week was excluded from the 2016 formulary of a rival benefit manager, Express Scripts, the nation’s biggest pharmacy benefit manager.
Pharmacy benefit managers, which administer drug benefits for employers and health plans, and also run large mail-order pharmacies, have been challenging the rising cost of new medications. When drugs are knocked off their formularies, patients may have to pay full price. Benefit managers often keep or exclude a product depending on whether they can obtain favorable pricing.
Viagra, made by Pfizer, is the world’s first approved pill for erectile dysfunction. It has annual sales of $1.8 billion, including $1.3 billion in the United States. Cheaper generic versions are expected to be available by December 2017.
The CVS formulary, however, does include Eli Lilly’s rival erectile dysfunction treatment, Cialis.
Next year’s formulary will also exclude two interferon-based multiple sclerosis treatments from Biogen: the popular Avonex and its new, longer-acting Plegridy. Avonex, Biogen’s second-biggest product, has annual sales of almost $2.5 billion.
Johnson & Johnson’s two-year-old diabetes treatment, Invokana, and a related combination treatment called Invokamet, will also be stripped from CVS coverage. Combined sales of the medications have been growing rapidly, reaching $318 million in the second quarter.
