Cigna Removes Brands in Favor of Generics for 2023

Cigna and Express Scripts have released their Standard Drug List for 2023, removing or excluding 42 branded therapies mostly in favor generics, and moving 11 drugs to higher tiers. (See below for full list of products removed, moved to a higher tier, and moved to lower tier.) Most of the brands that have been removed fall into the categories of hormonal therapies, pain and inflammatory conditions or skin conditions or high blood pressure/heart medications.

“These formulary updates will drive greater affordability for our clients and customers while ensuring that customers have access to clinically effective medicines,” a spokesperson from Cigna told Formulary Watch. “All formulary decisions are driven first by clinical consideration made by an independent committee of practicing physicians and pharmacists, and the final decision about a patient’s treatment rests with the individual and their doctor.”

Several branded medications have been removed in favor of generics, but the generic alternatives have restrictions placed on them, including oncology products. For example, the generic of Novartis’ cancer therapy Gleevec (imatinib) is now the preferred option, but the generic has a quantity limit. The medication treats several cancers, including those with mutations of the Philadelphia chromosome such as chronic myeloid leukemia and acute lymphoblastic leukemia, as well as KIT mutations in gastrointestinal stromal tumors and myelodysplastic/myeloproliferative disease and aggressive systemic mastocytosis. The lowest retail price for the generic of imatinib 400 mg is $114.49 for 30 tablets and an average retail price of $4,495.58, according to GoodRx.

In total, Cigna has 38 oncology products listed with quantity limits, including five generics. In addition to imatinib, other generics with quantity limits include:

• lapatinib, the generic of Novartis’ Tykerb used to treat patients HER2-positive breast cancer; the lowest price of lapatinib 250 mg is $1,620 for 105 tablets, according to GoodRx.
• lenalidomide, the generic of Bristol Myers Squibb’s Revlimid to treat patients with myelodysplastic syndrome (MDS), multiple myeloma, and mantle cell lymphoma; GoodRx only list the average retail price of $14,833.43 for 21 capsules of 10 mg lenalidomide.
• sorafenib, the generic of Bayer’s Nexavar to treat patients with hepatocellular carcinoma, renal cell carcinoma and differentiated thyroid carcinoma; GoodRx shows the lowest retail price of $3,236 for 60 tablets of 200 mg sorafenib.
• sunitinib, the generic of Pfizer’s Sutent to treat patients with gastrointestinal stromal tumor (GIST), pancreatic neuroendocrine tumors, and kidney cancer. The lowest retail price for 28 capsules of 37.5 mg sunitinib is $4,685, according to GoodRx.

Another generic product with restrictions is Bausch Health’s Demser (metyrosine). The generic is preferred over the brand, but the generic requires a prior authorization. Demser is used to help manage blood pressure in those with rare pheochromocytomas (tumors of the adrenal glands). Standard of care is surgery to remove the tumor, but the medication is used for the preoperative management of patients or for patients when surgery is not recommended. GoodRx shows the lowest retail price of 180 capsules of 250 mg metyrosine as $17,696.

Additionally, both the brand of Horizon’s Vimovo (naproxen-esomeprazole) delayed release tablets and its generic have been excluded from the formulary. The therapy is a combination of a nonsteroidal anti-inflammatory drug for pain and a proton pump inhibitor, which decreases the risk of developing stomach ulcers. It is used to treat osteoarthritis, rheumatoid arthritis and ankylosing spondylitis in adults, as well as juvenile idiopathic arthritis in adolescent patients. Cigna instead recommends using two separate medications instead of the combination.

“We added quantity limits to a few medication classes (both brand and generic) to protect patient safety,” the spokesperson said. “Medical management tools like prior authorization help protect patient health and safety – ensuring that the right patient gets the right drug at right dose at the right time - and improve affordability by reducing unnecessary costs. Most often, they apply with medicines that are unsafe when combined with other drugs, medicines that have lower-cost, equally effective alternatives, or medicines that are commonly misused.”