Express Scripts’ National Preferred Formulary (NPF) is the most widely used drug list in the United States, providing prescription drug coverage guidelines for 25 million Americans. In 2017, our members and plan sponsors will see small changes in their coverage, which will allow a large increase in value. Approximately 0.12% of our NPF members will be asked to use a different medication that achieves the same health outcome than one they are currently using. If any of these patients have rare clinical needs that require a medication that’s not on the formulary, we have provided a pathway to have that drug covered.
Out of more than 3,900 drugs available on the market, the 2017 NPF excludes 85. We exclude medications only when clinically equivalent alternatives are already covered on our formulary, and only when those exclusions will result in significant cost savings for our clients and patients. Participating plan sponsors will save approximately $1.8 billion throughout the year, the biggest annual savings since the NPF was introduced in 2014.
Click here for a list of the 85 medications that will be excluded from Express Scripts’ 2017 National Preferred Formulary, along with the clinically equivalent alternatives that remain covered.
Clinical factors come first
Our unique approach to formulary development is guided by an independent panel of clinical experts and calls for a focus on clinical factors, with financial considerations coming into play only among clinically comparable or optional products. This results in clinically sound, cost-effective formularies.
By opening up access to all clinically superior medications and excluding a handful of “me-too” products that have no clinical benefit beyond what’s provided by more affordable alternatives, we have leverage to negotiate more effectively with manufacturers and ultimately achieve lower drug prices for the clients and patients we serve.
Looking to the future
As we have done in previous years, we will review new drugs as they come to market to assess if additional formulary updates are necessary. We will approach these updates with the same level of consideration for patient care as we do with our annual updates.
In tandem with the NPF, Express Scripts has pioneered a number of programs to reduce costs for plan sponsors while ensuring that patients get the medications they need. For example, we offered the industry’s first brand inflation protection guarantee. Our Hepatitis Cure Value Program® saved clients $1 billion in 2015 alone and was awarded PBMI’s Excellence Award in the Cost Containment category. Our Cholesterol Care Value ProgramSM allows plan sponsors to avoid up to 90% of plan cost increases for pricey new PCSK9 inhibitors, and our Oncology Care Value ProgramSM aligns cost with efficacy for select drugs. Later this year, we expect to provide details about future innovative solutions, including our Diabetes Care Value ProgramSM, Inflammatory Conditions Care Value ProgramSM and Market Events Protection ProgramSM.
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