CVS Caremark Removes, Adds Products to Formulary

CVS Caremark has removed 13 products and added 30 products to its preferred formulary, according to a Formulary Watch^® review of the Performance Drug List - Standard Control formulary. Editors compared the formulary effective January 2023 that is available on the company's website with the October 2022 list. A CVS Caremark spokesperson identified additional changes to the formulary, including 13 other products that have been removed and a nonpreferred product that has been added. (See Table below for a full list of removals and additions.)

Previously, a spokesperson for the company indicated that the formulary on the company’s website may not accurately reflect the total counts because it only identifies preferred products and there may be impacts to non-preferred products as well.

“Our template formularies remain critical tools in helping to provide our clients’ members with coverage of clinically appropriate medicines at the lowest possible cost,” a spokesperson told Formulary Watch^®. “Our formularies help clients manage costs as they strive to recover from the economic impact of COVID-19 and mitigate inflationary pressure.”

Several brand name drugs have been removed in favor of other branded drugs on CVS Caremark’s formulary. One product added is Sanofi’s Alprolix (coagulation Factor IX recombinant) to treat hemophilia B. Alprolix was approved in 2014, and Sanofi acquired the therapy when it bought the company Bioverative in 2018. CVS Caremark now recommends both Alprolix and Novo Nordisk’s Rebinyn as alternatives for several hemophilia therapies, including Pfizer’s Benefix, Medexus Pharmaceuticals’ Ixinity and Takeda’s Rixubix. Rebinyn was already a covered therapy on the PBM’s preferred list.

Alprolix has an average retail price of $16,436.62, according to GoodRx. Sanofi offers financial assistance programs for Alprolix, including a free trial program, co-pay assistance of up to $20,000, and an access program for patients whose insurance has been interrupted.

CVS Caremark has also added two cancer therapies that are now preferred over other brands. Inlyta (axitinib) and Lenvima (lenvatinib) are now among the preferred options for Sutent (sunitinib) and Votrient (pazopanib), both of which have been removed. Pfizer’s Inlyta is approved to treat kidney cancer while the company’s Sutent is approved to treat sunitib kidney, stomach, bowel, and esophagus cancer. Eisai’s Lenvima is approved to treat thyroid, liver and kidney cancer while Novartis’ Votrient is approved to treat kidney cancer and soft tissue sarcoma.

Additionally, newly approved generics have displaced several branded products on CVS Caremark’s formulary. One of these is Genentech’s Esbriet (pirfenidone) to treat idiopathic pulmonary fibrosis. In May 2022, Sandoz launched the first generic of Esbriet to treat patients with idiopathic pulmonary fibrosis, a rare progressive disease that causes irreversible lung scarring and makes it difficult to breathe. Since then, Accord Healthcare also launched a generic version. CVS Health also prefers Boehringer-Ingelheim’s OFEV (nintedanib) to Esbriet. OFEV is approved to treat patients with idiopathic pulmonary fibrosis as well as chronic fibrosing and sclerosis-associated interstitial lung diseases, which result in inflammation and/or scarring in the lungs.

Another drug removed in favor of a generic is Takeda’s Velcade (bortezomib) to treat multiple myeloma and mantle cell lymphoma. In May 2022, Fresenius Kabi introduced its generic bortezomib. The generic is available in a 3.5 mg per 10 mL single dose for subcutaneous or intravenous use.

Other removals include several asthma and pain medications. Within asthma, GlaxoSmithKline’s Arnuity Ellipta (fluticasone furoate) and Flovent Diskus (fluticasone proprionate), as well as Teva’s QVAR Redihaler (beclomethasone diproprionate). The preferred asthma medications for all three medications include Flovent HFA and AstraZeneca’s Pulmicort Flexhaler (budesonide).

In the pain area, CVS Health has removed Nucynta (tapentadol) and Nucynta ER developed by Collegium Pharmaceuticals and Subsys (fentanyl) pain from West Therapeutic Development.

Other additions to CVS’s formulary include several new and first-in-class products. One of these is Insulet’s automated insulin delivery system. Omnipod 5 insulin infusion pump was approved in January for patients six years of age and older and then in August for patients two years of age and older. Omnipod 5 is a system that integrates with the Dexcom G6 Continuous Glucose Monitoring (CGM) system and a compatible smartphone to automatically adjust insulin. The system consists of the tubeless Pod enhanced with SmartAdjust technology, the Omnipod 5 mobile app with its integrated SmartBolus Calculator, and the Dexcom G6 CGM.

Every five minutes, SmartAdjust receives a Dexcom CGM value and trend, and predicts where glucose will be 60 minutes into the future. The system then increases, decreases, or pauses insulin delivery using the user’s glucose target. Omnipod 5 was selected as a CES 2022 Innovation Award honoree in two categories: Health and Wellness and Wearable Technologies. The CES Innovation Awards is an annual competition honoring outstanding design and engineering in consumer technology products.

Omnipod 5 is available at pharmacies with an average retail price of $912.31, according to GoodRx.

CVS Health also added to its formulary several products approved by the FDA in 2021. One is Leo Pharma’ Adbry (tralokinumab-ldrm) to treat patients with atopic dermatitis. Approved December 2021, it is a biologic that inhibits the interleukin (IL)-13 cytokine, a key driver of atopic dermatitis signs and symptoms. It is the only therapy that targets IL-13. It is marketed outside of the United State under the tradename Adtralza. According to GoodRx, the lowest retail price the most common version of Adbry (two cartons with two syringes each) is around $3,303.62; the average retail price of $6,681.37.

Another therapy added to the CVS formulary is AbbVie’s Qulipta (atogepant), which was approved in September 2021 and is the only oral calcitonin gene-related peptide receptor antagonist (gepant) specifically developed for the prevention of migraine. The lowest retail price for 30 tablets of 60 mg of Qulipta is around $983.54; average retail price of $1,194.51, according to GoodRx.

Another new product added to the CVS Caremark formulary is Tezspire (tezepelumab-ekko), which was approved in December 2021 as an add-on maintenance treatment of adult and pediatric patients aged 12 years and older with severe asthma. Developed by Amgen and AstraZeneca, it is the first biologic option for severe asthma. The list price is $3,633 per 210 mg/mL, according to the companies.

Additionally, the PBM also added Twyneo, a combination product of tretinoin and benzoyl peroxide approved in July 2021. The acne therapy was developed by Sol-Gel Technologies, which partnered with Galderma for U.S. commercialization. Twyneo uses silica-based microcapsules to stabilize tretinoin from being degraded by benzoyl peroxide and to slowly release each of the active drug ingredients over time. The GoodRx lowest retail cost for 30 g is $426.60; the average retail price of $514.50.