Thursday, July 31, 2014

Drug Channels News Roundup, July 2014: Formulary Exclusion, Specialty Pharmacy, Narrow Networks, and Weird Al

Given all of the news lately, the hazy days of summer have not been very lazy. Put your feet up and relax with this month’s selection of noteworthy news stories. In this issue:
  • First Round of PBM 2015 Formulary Exclusions Announced
  • How To Win in Specialty Pharmacy
  • Narrow Networks Are Here to Stay
Plus, the great Weird Al Yankovic returns to take on corporate jargon. On behalf of consultants everywhere, I apologize.

Horizon Pharma 8-K Filing on Formulary Exclusion
In last month’s news roundup, I noted that a New York Times’ report that CVS Caremark is planning a formulary with more than 200 excluded drugs. We got the first public hint with Horizon Pharma's July 28 8-K filing, which stated:
We have been verbally notified that in August 2014, two pharmacy benefit managers (‘PBMs’), CVS Caremark (‘Caremark’) and Express Scripts, Inc. (‘ESI’), expect to announce DUEXIS® and VIMOVO® will no longer be on their formularies and will be placed on their exclusion lists effective January 1, 2015.
Yikes. Express Scripts plans to announce its full 2015 exclusion list soon. For context and background, see Express Scripts and the Inevitability of Formulary Exclusion.

Pathways to Specialty Pharmacy, Drug Topics
Drug Topics has a good article on the opportunities and challenges from specialty pharmacy’s growth. Here’s what I told DT: “Pharmacies need to make a choice as to how they are going to survive in this new world that’s going to be here within three to five years. Fundamentally, pharmacies need to change or die.

A Health Trade-Off That’s Here to Stay: Lower Cost, Limited Choice, The New York Times
The Affordable Care Act limited how health plans could use the traditional tools to control provider costs, so it’s no surprise that narrow networks are key feature of almost half of the plans sold on exchanges. This article is a useful reminder that the growth of preferred and limited pharmacy networks reflects broader healthcare changes, not some grand anti-pharmacy conspiracy.

Mission Statement, Weird Al Yankovic
Great new album from Weird Al! Thanks to my teenage kids, I even recognize all of the songs. Don't forget to turn up your speakers. Click here if you can't see the video. (FYI, Weird Al’s Word Crimes is all kinds of awesome, too.)


  1. interesting...but will the hard workers: the employees benefit from this change?

  2. How saleable do you think the limited formularies offered by CVS and ESI will be? Granted they should show tremendous cost savings but I wonder what the prospect client appetite will be for these products.