Despite targeting cancer drugs for the first time, trickle-down effects of pharmacy benefit managers' (PBMs') 2017 exclusion lists will not likely have a major impact on prescribing and coverage decisions, experts said.
Two of the largest PBMs, CVS Health's (NYSE:CVS) Caremark division and Express Scripts (NASDAQ:ESRX), released their 2017 formulary exclusion lists earlier this month. While Express Scripts did not target cancer, CVS added Astellas Pharma (TYO:4503) and Medivation's (NASDAQ:MDVN) prostate cancer drug Xtandi (enzalutamide).
CVS' exclusion of Xtandi is a relatively major shift, in terms of targeting oncology drugs, an analyst report noted.
While acknowledging that Xtandi's exclusion was a first among oncology drugs and would make a dent in new prescriptions, experts said since large health plans and local formularies make their own coverage decisions, Xtandi's exclusion will not be absolute. Additionally, they noted, provisions like prior authorization or step edits will be used, and patients may be responsible for higher co-pays.