Express Scripts Releases List of 2022 Formulary Exclusions

Four products on the preferred list this year will be excluded next year.

Express Scripts, part of Cigna’s Evernorth company, has released its 2022 list of exclusions for its national preferred formulary. Compared with 2021, the list for next year's exclusions includes 35 new products.

Since 2014, Express Scripts national preferred formulary has saved clients $23.9 billion in annual, incremental value, officials said in an email to Formulary Watch.

Last year, the company's commercial clients' drug spend increased 4%. “For the first time, specialty drug spending surpassed traditional drug spending. The national preferred formulary helps to drive savings for plan sponsors while ensuring members have access to medications that keep them healthy. We do this by preferring lower net-cost drugs, and using our scale to negotiate deeper discounts on historically costly classes,” a spokesperson said.

Company officials say updates to the national formulary are driven first by clinical consideration made by an independent committee of actively practicing physicians and pharmacists.

“Beginning January 1, 2022, the the national preferred formulary (NPF) will exclude 32 additional products, but changes will not impact 99.74% of the members utilizing the NPF. The small percentage who are affected will receive personalized communications educating them about their options, and we will notify their physicians and pharmacists before the exclusions are implemented,” a company spokesperson said.

One of the now-excluded products is Merck’s Zioptan (tafluprost ophthalmic solution), a prostaglandin to reduce elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension. Open-angle glaucoma is the most common form of glaucoma; ocular hypertension is a condition characterized by an increase in pressure inside the eye.

Zioptan joins Allergan’s Durysta and Sun Pharma’s Xelpros on the exclusion list for antiglaucoma agents. The preferred alternatives continue to be bimatoprost drops, latanoprost drops, and travoprost drops, all generic agents.

Additionally, Abbvie’s Lumigan has been dropped from the preferred list for glaucoma treatment.

Pfizer’s Nyvepria (pegfilgrasim-apgf) is another therapy previously on Express Script’s 2021 preferred alternatives that is now excluded from the national formulary. Nyvepria is a supportive therapy used to fight infection in patients with cancer. Nyvepria is a biosimilar to Amgen’s Neulasta (pegfilgrastim) and it received FDA approval in June 2020. It joins Neulasta and Udenyca (pegfilgrastim-cbqv), another biosimilar, on the excluded list.

Preferred alternatives for this class include two other biosimilars, Ziextenzo (pegfilgrastim-bmez) and Fulphila (pegfilgrastim-jmdb).

A third therapy on next year’s exclusion list that was formerly preferred is Zerviate (cetirizine ophthalmic solution), a treatment for allergic conjunctivitis, developed by a French company Nicox. This year, it is the only branded therapy for allergic conjunctivitis on the preferred list. In 2022, all the preferred products for allergic conjunctivitis are generics, including azelastine drops, bepotastine drops, cromolyn drops, epinastine drops, and olopatadine drops.

Alrex (loteprednol ophthalmic), another therapy in this class, also joined the 2022 exclusion.

The fourth product that moved from preferred to excluded is Otovel (ciprofloxacin and fluocinolone acetonide), which is used to treat ear infections in children with ear tubes. It was developed by Salvat, a Spanish company, and marketed in the United States by Arbor Pharmaceuticals. In this class, Cipro HC is an addition to the excluded products list.The preferred is now the ciprofloxacin/dexamethasone otic.

Other therapies that have been added to Express Scripts exclusion list are in the table below.

Cigna acquired Express Scripts in December 2018. It is now part of the Cigna subsidiary Evernorth Health, which also includes Accredo, eviCore and MDLIVE companies. Evernorth fulfilled 410 million adjusted pharmacy scripts in second quarter 2021, an increase of 13% over second quarter 2020 driven by strong organic growth and COVID-19 vaccines, according to Cigna’s second quarter 2021 earnings release.

Since 2014, Express Scripts national preferred formulary has saved clients $23.9 billion in annual, incremental value, the spokesperson said.

PBMs develop national formularies based on clinical appropriateness and cost consideration but clients may adjust and adapt them. Express Scripts developed its formulary through a four-step process involving the work of three distinct committees: the therapeutic assessment committee, the national pharmacy and therapeutics committee, and the value assessment committee.