Bloomberg: CVS Will Exclude Xtandi From Formulary in 2017
Bloomberg reported on August 2, 2016, that CVS Health announced that it plans to exclude 35 drugs from its formulary beginning in 2017, including Xtandi, bringing the total number of excluded drugs to 131.
CVS will continue to reimburse Zytiga (abiraterone), a drug for prostate cancer that is marketed by Janssen. AS KEI noted, one study found that Xtandi would be more cost-effective than Zytiga if the price was decreased by at least 26%.
CVS operates various prescription drug services, including Caremark, one of the largest U.S. pharmacy benefit managers, as well as the largest Medicare Part D insurer, SilverScript, which covers over 5 million Medicare patients. CVS reported that its pharmacy services businesses earned $28.8 billion in net revenue in the first quarter of 2016
This exclusion marks the first time that CVS has removed a brand-name cancer medicine from its formulary. According to a press release, CVS plans to remove the 35 drugs from its formulary to “help reduce costs for clients and plan members.” CVS also explained that 10 of the drugs to have their coverage revoked are “hyperinflationary drugs,” defined as “products with egregious cost inflation that have readily-available, clinically-appropriate and more cost-effective alternatives.”