CVS Caremark Announces Formulary for 2022

CVS Caremark has released its Performance Drug List, Standard Control, for January 2022. Effective January 1, the company has removed 10 branded products from its Standard Control formulary and added about 30 products when compared with its most recent list effective October 2021. (See Table 1 below for products removed, and Table 2 below for products added.)

According to a company spokesperson, the vast majority – more than 99.6% – of CVS Caremark’s 100 million members will be able to stay on their current therapy. “We have used formulary management and preferred placement to negotiate better pricing and greater discounts to reduce costs for payers when clinically equivalent alternatives are available. We remain focused on ensuring that members get access to clinically appropriate medicines at the lowest possible cost – despite skyrocketing prices and the fact that only pharmaceutical companies set list prices for medicines and vaccines,” the spokesperson said by email.

The products removed from CVS Caremark’s Performance Drug List span a variety of classes and indications. Although some are older products with a generic available as an alternative, some products are newer and the company does not provide an alternative.

One therapy that was removed is Novartis’ Afinitor (everolimus), which is an anticancer agent approved to treat patients with breast cancer, neuroendocrine tumors of the lung and gastrointestinal, kidney tumors, and renal cell carcinoma. But CVS has included Afinitor Disperz, which is a tablet formulation of everolimus for oral suspension, as an alternative.

Several generics of Afinitor have been approved and are available. The first generic was launched in December 2019 when Par offered three strengths: 2.5 mg, 5 mg, and 7.5 mg. More recently, Biocon launched a generic everolimus in October 2021. Biocon launched four strengths: 2.5 mg, 5 mg, 7.5 mg and 10 mg.

Another therapy removed is Amgen’s Aranesp (darbepoetin), which is used to treat anemia in patients with chronic kidney disease and in patient undergoing chemotherapy. This is, however, an older therapeutic, first approved in 2001, and CVS Caremark recommends Retacrit (epoetin alpha-epbx) as an alternative, which the FDA approved in May 2018. Retacrit, developed by Pfizer, is the biosimilar of Epogen/Procrit, which is also used for the same indication.

Another removed therapy is Complera from Gilead Sciences, which is a combination of emtricitabine, rilpivirine, and tenofovir disoproxil fumarate to treat patient with HIV. In addition to the generics that are available, CVS Caremark recommends Biktarvy, Dovato, Genvoya, Odefsey, Stribild, Symtuza, and Triumeq.

Eliquis (apixaban), from Bristol Myers Squibb, was also removed from CVS Caremark’s drug list. It is an anticoagulant approved to treat and prevent blood clots and stroke. The company recommends warfarin or Janssen’s Xarelto (rivaroxaban) as an alternative.

The FDA approved Symjepi (epinephrine) for the emergency treatment of acute allergic reactions. It was developed by Adamis Pharmaceuticals, who in 2018 licensed U.S. rights to Sandoz. As an alternative for Symjepi, CVS Caremark recommends Epipen, Epipen Jr. and Auvi-Q, which will be added to CVS Caremark’s Performance Drug List in January 2022.

Among those products removed with no alternatives is Reyvow (Lasmiditan). Lilly launched Reyvow in January 2020 to treat adult patients for the acute treatment of migraine with or without aura. Reyvow is the first of a new class of acute treatment for migraine, a serotonin (5-HT) 1F receptor agonist (ditan), which are thought to play a role in migraine.

Although Caremark does not suggest an alternative, the plan does have on its drug list Biohaven’s Nurtec ODT (Rimegepant), another first-in-class migraine therapy. The FDA approved Nurtec ODT in February 2020 as the first calcitonin gene-related peptide (CGRP) receptor agonist for acute treatment of migraine. The FDA also approved Nurtec ODT in May 2021 for the prevention of migraine.

Other therapies removed from CVS’s formulary with no alternative, include Dova Pharmaceuticals’ Doptelet (avatrombopag), which was approved in 2018 to treat thrombocytopenia in adults with chronic liver disease; Picato (ingenol), which was discontinued by its manufacturer, LEO Pharma; and Tolak (fluorouracil) topical cream, which is approved to treat actinic keratosis

See below for Table 2 of products added to CVS Caremark formulary.

Table 1: Drugs Removed from CVS Caremark Performance Drug List, Standard Control

Effective January 1, 2022

Table 2: Drugs Added to CVS Caremark Performance Drug List, Standard Control

Effective January 1, 2022