UPDATED: CVS Caremark Drops Several Products from Drug List

CVS Caremark has released its updated Performance Drug List, Standard Control formulary list. Effective July 1, the company has removed seven products from this formulary, according to a review conducted Formulary Watch comparing the April 2022 and the July 2022 Standard Control Formulary lists. (See table below for a list of the products added and removed.)

A CVS Caremark spokesperson indicated that an additional nine drugs have been removed. "The Performance Drug List, Standard Control formulary list, may not accurately reflect the total counts as it only identifies preferred products and there may be impacts to non-preferred products as well," she told Formulary Watch.

“Our template formularies remain critical tools in helping clients save money as they recover from the economic impacts of COVID-19, while continuing to provide affordable prescription drug benefits to their members,” the spokesperson said. “It’s important to note that the vast majority of our 100 million CVS Caremark members will be able to stay on their current therapy.

“Since CVS Caremark was the first PBM to implement formulary exclusions in 2012, we have used formulary management 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.”

CVS Caremark has also added 14 products, including Eliquis (apixaban), which had been excluded from the drug list for this year. The CVS Caremark spokesperson said they was able to secure a lower net cost through negotiations with the manufacturer. But this change doesn’t not appear on the list just published on CVS Caremark’s website. The spokesperson said the change will be reflected the next time the formulary documents are updated, which is currently scheduled in advance of October 1, 2022.

Eliquis, developed by Bristol Myers Squibb, is an anticoagulant approved to treat and prevent blood clots and stroke. The decision to put Eliquis back on the formulary comes after objections from patients and patient groups. The American College of Cardiology and the American Society of Hematology have been involved in pushing back on CVS Caremark’s formulary decision.

The alternatives CVS Caremark had recommended for Eliquis included warfarin or Xarelto (rivaroxaban). This exclusion sparked concern among doctors and patients about “non-medical switching.” Patient and patient advocate Beth Waldron had been outspoken about the negative impact this exclusion could have on patients.

Waldron had been notified by mail in November 2021 that Eliquis, a therapy she had been taking eight years and was stable on, would no longer be covered. “For me personally, for my type of blood clots, the clinical studies show that patients have lower risk of recurrent clot and lower risk of major bleeding—including intracranial and serious internal bleeding abdomen while taking Eliquis,” she said in a recent interview.

A study published in January 2022 in the Annals of Internal Medicine showed that patients with venous thromboembolism (VTE) who started on Eliquis had lower rates for recurrent VTE and bleeding than those who started on Xarelto.

One product removed is Novartis’ Afinitor Disperz (everolimus tablets for oral suspension), an anticancer agent approved to treat patients with breast cancer, neuroendocrine tumors of the lung and gastrointestinal, kidney tumors, and renal cell carcinoma. Several generics 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. It was approved in February 2021. Biocon launched four strengths: 2.5 mg, 5 mg, 7.5 mg and 10 mg. Additionally, Breckinridge Pharmaceutical launched a 10 mg strength of generic everolimus in October 2021. The company had launched the three other strengths in the second quarter of 2021.

Afinitor Disperz tablet for oral suspension is also approved for the treatment of tuberous sclerosis complex (TSC)-associated subependymal giant cell astrocytoma and TSC-associated partial-onset seizures. On October 1, 2021, Mylan/Viatris launched the first generic version for this indication.

Also removed is Novo Nordisk’s GlucaGen Hypokit (glucagon) and Freenius Kabi’s Glucagon emergency kit, which are used to treat low blood sugar in patients with diabetes. CVS Caremark’s recommended alternatives include recommends Lilly’s Baqsimi (glucagon nasal powder), Xeris Pharmaceuticals’ Gvoke, (glucagon injectin) and Zealand Pharma’s Zegalogue (dasiglucagon injection), which has been added to the Standard Control Formulary beginning in July. The FDA approved Zegalogue in March 2021.

Other products removed include Movantik (naloxegol) to treat constipation that is caused by opioids, from RedHill Biopharma, Pentasa (mesalamine) to treat and prevent flare-ups of ulcerative colitis from Takeda Pharmaceuticals, and Dexilant (dexlansoprazole) to treat erosive esophagitis and heartburn associated with symptomatic non-erosive gastroesophageal reflux disease from Takeda Pharmaceuticals.

According to a CVS Caremark spokesperson, additional drugs removed from the formulary but not indicated on the Standard Control Formulary include:

• diclofenac tablet 25 mg, Lofena

• KEPPRA, KEPPRA XR

• LAMICTAL, LAMICTAL XR

• QUILLICHEW ER, QUILLIVANT XR

• TAFINLAR

• MEKINIST

• JUXTAPID

• CAYSTON

• DUOBRII

*This story has been updated to provide additional information from CVS Caremark.