Is Express Scripts' New NPF "Patient Unfriendly"?

From RADAR on Drug Benefits

As of Jan. 1, Express Scripts Holding Co. will introduce 48 new formulary exclusions in its 2019 National Preferred Formulary (NPF). While an industry expert describes one new exclusion for a hepatitis C drug as "a patient unfriendly change," an Express Scripts spokesperson contends that patients, not cost, come first.

Adam Fein, Ph.D., president of Pembroke Consulting, Inc. and CEO of Drug Channels Institute, notes that Express Scripts, for the first time, excluded products in two specialty categories: HIV antiretrovirals and Factor VIII recombinant products for hemophilia treatment.

In the hepatitis C category, the PBM says it will exclude AbbVie's Mavyret, which Fein describes as "the market share leader with a low list price." The formulary will add Merck's Zepatier, "whose list price was recently cut but can’t treat all types of hepatitis C," Fein says.

"Consequently, the [Express Scripts] 2019 preferred formulary will force at least one in four patients to use the products with high list prices and high rebates," Fein says. "Many patients will end up incurring much higher out-of-pocket costs. Incredibly, Express Scripts advocates copay cards as a fix!"

In the press release announcing its 2019 NPF, Express Scripts explains that, "after clinical considerations, formulary preference is given to high-value therapies with the lowest net cost, achieved through low list price, rebate, or both."

Thus, for hepatitis C treatment, the PBM says its upcoming formulary "will prefer low-price leader" Zepatier "and market leaders" Harvoni, Epclusa and Vosevi in place of Mavyret.

Express Scripts' Jennifer Luddy cites "a lot of value" in the PBM’s new NPF. Upcoming changes will save plans an estimated $3.2 billion for the 2019 plan year, with cumulative savings for plans leveraging NPF since 2014 totaling $10.6 billion, she says. Its national formulary, which covers more than 25 million people, will provide access to 3,886 medications next year.

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