Top 5 things to know about Express Scripts’ new formulary

Express Scripts’ new National Preferred Flex Formulary, which offers lower list prices on certain branded drugs, is a novel way to encourage pharma makers to lower prices.

The Flex Formulary, available January 1, “provides employers and health plans a pathway to cover lower list price products, helps deliver lower member out-of-pocket costs, and reduces reliance on brand rebates,” said Express Scripts in a statement.

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Here are the top 5 things to know about the new formulary:

1. The Flex formulary is a comprehensive formulary that will cover more than 3,800 medications, including generics and biosimilars.

2. When a manufacturer launches a lower-cost authorized alternative to a branded medication on the market, Express Scripts will evaluate the product for placement on the National Preferred Flex Formulary. If appropriate, the authorized alternative product will be added to the Flex Formulary with preferred or possibly non-preferred status, Express Scripts said. “The innovator brand-name product, and potentially other products in the therapy class, then will be excluded from coverage,” the PBM added.

3. The Flex Formulary is designed to allow employers and commercial health plans an opportunity to choose between a formulary that achieves lowest net cost via a rebate, or a formulary that achieves lowest net cost through lower list price drugs, Jennifer Luddy, director of communications for Express Scripts, told FormularyWatch. The benefit of the Flex Formulary is to members who have a high-deductible plan design or coinsurance and pay the full cost of their medication until their deductible amount is achieved, Luddy said. “If their plan uses the Flex Formulary, they will benefit from having access to the lowest price product.”

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4. While there are currently only two drugs (Epclusa and Harvoni) on the Flex Formulary that achieve lowest net cost through an authorized alternative that has a low list price, Luddy expects there to be more manufacturers “who bring such alternatives to market,” she said.

5. The Flex Formulary came about after the PBM responded to the President’s Blueprint on Drug Pricing. “We suggested the idea of drug makers introducing alternate NDCs [National Drug Codes] for existing brands so the manufacturer could introduce them at a lower price without disrupting the supply chain,” Luddy said.

After making the recommendation, Gilead announced the launch of a new subsidiary that would bring authorized alternatives for Epclusa and Harvoni to market under new NDCs. Amgen followed a few weeks later with Repatha, according to Luddy. “Once we saw more and more drug makers acting on this recommendation, we built the Flex Formulary so our clients would have an opportunity to leverage it.”

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