PBMs Formulary Exclusions Continue to Grow

Cigna Corp.-owned Express Scripts will exclude 32 additional medications from its 2022 National Preferred Formulary, while the other two major PBMs — CVS Health Corp.’s Caremark and UnitedHealth Group’s OptumRx — will both cut 20 additional drugs from their formularies in 2022. Since 2014, the three PBMs have dramatically increased the number of excluded drugs, but the growth rate of exclusions has slowed in recent years. Graphics below list medications that will be excluded by major PBMs due to 2022 formulary changes and their current market access among commercial formularies under the pharmacy benefit. For many of these drugs, fewer than half of covered lives are under the preferred tier/preferred with prior authorization or step therapy and covered tier/covered with PA/ST.

SOURCES: “2022 National Preferred Formulary Exclusion List Changes,” Express Scripts. “2022 CVS/Caremark Prescription Drug Formulary Changes,” CVS Health. “Pharmacy Passages, Formulary Update,” OptumRx. Managed Markets Insight & Technology, LLC database as of February 2022.

From Radar on Drug Benefits