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We came across an interview with Steven Miller, the Chief Medical Officer at Express Scripts recently about the stir his company has created in its decision to remove 48 medications from its national preferred formulary.

Our immediate reaction: Why is this news?

OK, we understand why it’s news. The biggest PBM has decided to remove certain medications from its formulary. That has real and significant revenue implications for the drugs’ manufacturers and potential implications for patients in reduced medication choice (although Dr. Miller goes to great length to refute that latter point).

But, still, why is this news?

Isn’t it the job of the Pharmacy & Therapeutics (P&T) Committee at every health plan and health system to review medication options regularly and make decisions to add or remove drugs from the formulary? Apparently not. Until now, according to Express Scripts, the job has been to add drugs to the formulary as they come to market but only to remove them when there is an FDA action or other major safety concern.

We agree wholeheartedly with Dr. Miller that this practice is going to change. And not only because of the reasons cited in his interview (comparable medicines, product cost, the proliferation of co-pay cards, and others).

The reason this practice is going to change is due to the proliferation of post-marketed drug safety data that is quickly becoming available in the managed care market. With the right data in hand, we expect P&T committees nationwide to take more regular action to remove drugs from their formularies (or adjust their tier standing, co-pays, etc) when it becomes clear that safety, patient outcomes, and quality of care are suffering- and not just when the FDA decides to issue a safety alert.

At AdverseEvents we are debuting new products and services that enable our managed care clients to see emerging safety issues among marketed drugs before the FDA takes a safety action. In some cases, our evidence-based data can signal a strong case for a formulary change or removal five years before the FDA takes action. In those five years, millions of patients’ lives can be positively impacted through better outcomes and millions of dollars in medical costs can be saved by the health plan. All for making the simple decision to remove a medication from a formulary.

So, we ask again: Why is ExpressScripts’ decision news?

UPDATE: Make sure to see our follow up post  Did Express Scripts Make the Right Formulary Exclusions? and follow the link for more information about the Formulary Optimization work we do.


Brian Overstreet

Brian Overstreet


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Topics: Managed Care

Brian Overstreet

Written by Brian Overstreet