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2018-11-14 Express Scripts New Formulary

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Express Scripts Announces New Formulary Design Option

Posted: November 14, 2018

This week, Express Scripts announced that it would provide clients with the ability to opt for its new National Preferred Flex Formulary Design. As opposed to favoring drugs that garner the most rebate dollars, the new benefit design intends to favor drugs that have lower list prices to begin with.

CSRO has bemoaned the rebate system as a key driver of list price inflation, and applauds efforts to move away from a practice that allows profiteering at the expense of the sickest patients.  The new benefit design’s stated goal is laudable, but questions remain about the details. The Alliance for Transparent and Affordable Prescriptions has regularly identified reclassification of rebates incomes as other “fees” as a continuing problem with discussions around the pharmaceutical supply chain. What sway will these non-rebate “fees” hold in the design of Express Script’s new formulary?

CSRO is also concerned that the new formulary design could negatively impact chronically ill patients via non-medical switching. According to Express Scripts health plans may now choose “authorized alternative products” that can be substituted for on formulary products when price changes occur. Express Scripts notes that the previously available product may be excluded from coverage. While CSRO recognizes that controlling drug spend is necessary, it would be irresponsible to switch many chronically ill patients in this manner. For patients that would be adversely impacted by such switching, Express Scripts should offer the ability to continue on the previously available therapy at the previous cost-sharing level.

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