Our 2016 National Preferred Formulary

Jul 31, 2015
Through appropriate formulary management, medicine is made more affordable and accessible.

While Express Scripts manages many formularies – or drug lists – for the clients and patients we serve, our National Preferred Formulary (NPF) is the most widely used formulary in the United States, providing prescription drug coverage guidelines for 25 million Americans. Guided by an independent panel of clinical experts, today we are announcing updates for our 2016 National Preferred Formulary.

Many therapy classes have more drug choices than ever, with some prescription drugs costing more but delivering no additional health benefit. One of the ways we keep costs down for patients and payers is by managing the formulary. 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.

Next year, out of more than 4,000 drugs available on the market, we will offer a formulary that excludes 80. For each one of those excluded drugs, there are clinically equivalent, lower-cost options available. With the National Preferred Formulary, our plan sponsors will save approximately $1.3 billion throughout the year, creating more than $3 billion of total savings for those plans since 2014.

Total National Preferred Formulary Value 3B in Three Years 

Taking a Selective Approach to Exclusions, Maintaining Access for Patients

We look at the formulary first from a clinical perspective to ensure that it provides access to safe and effective medications in all therapy classes. In doing so, we rely on an independent group of physicians who review extensive clinical data to determine which medications provide significant health benefits beyond what is achievable with other medication options. Secondly, and only after the clinical requirements have been achieved, we evaluate the formulary for its cost-effectiveness. We will only exclude medications from our formulary when clinically equivalent alternatives are already covered on our formulary, and only then when those exclusions would result in significant cost savings for our clients and patients.

In 2016, fewer than 0.5% of our NPF members will be asked to use a different medication that achieves the same health outcome than one they are currently using. And if one of these patients has a rare clinical need that requires a specific medication that’s not on the formulary, we have provided a pathway to have the drug covered.

Through Appropriate Formulary Management, Medicine Is Made More Affordable and Accessible

Since Express Scripts began excluding medications from this formulary in 2014, we have changed the marketplace dynamic. And in addition to the $3 billion in savings delivered to our NPF clients, our Hepatitis Cure Value Program generated an additional $1 billion in savings to our clients this year while expanding patient access to curative therapies.

And as the plan sponsors we represent have demonstrated that they are willing to exclude medications that are priced above clinically equivalent alternatives, manufacturers are now approaching us earlier to ensure the affordability and accessibility of their products. As a result, we have been able to drive significant value for our clients and patients, with minimal disruption in the form of additional formulary exclusions. 

On the Horizon

Today, we are providing our annual update to our National Preferred Formulary. However, as we did with our 2015 formulary, we will review any new drugs as they come to market to assess if additional 2016 formulary updates are necessary. Whether with the PCSK9 inhibitors or in other therapy classes, we will approach any of these additional formulary updates with the same level of consideration for patient care as we do with our annual updates.

Additionally, as we have discussed before, we are currently developing a formulary product that will lower the cost to treat cancer by addressing specific indications. We expect to provide more details about this innovative solution later this year.

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Lab Staff
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