CVS Caremark returns Eliquis to formulary after protests

CVS Health will return the blood thinner drug Eliquis to its Pharmacy Benefits Manager’s Commercial Handbook effective July 1, reversing a decision that sparked outcry from doctors and patients the company notified suppliers last week.

CVS Caremark has entered into a new agreement with manufacturer Eliquis Bristol-Myers Squibb to acquire a prescription anticoagulant. Both Eliquis and Janssen Pharmaceutical’s Xarelto will be available to patients covered by PBM. For several months, CVS Caremark only included Xarelto, although studies have not shown interchangeability of the two drugs.

Patients, medical societies and advocacy groups such as the American College of Cardiology and the American Society of Hematology objected when CVS Caremark reported last year that Eliquis was leaving on a formula. A coalition called the Partnership for Better Cardiovascular Health described the formulary deletion as “dangerously damaging” in a December letter to Dr. Troyen Brennan, then the company’s chief medical officer.

CVS Caremark has decided to return Eliquis to its formulary after lower cost negotiations, a spokesperson said in an email on Wednesday. “Anticoagulant therapy is one of the fastest-growing non-specialty products for drug manufacturers, and we will continue to resist unreasonable price increases,” the spokesperson wrote.

The price of eliquis, also known as apixaban, rose 6% to $529 for a monthly supply in January compared to last year, according to the advocacy group Patients for Affordable Medicines. The report says that the cost of Xarelto, also known as rivaroxaban, increased by 4.9% over the same period to $516 per month. Because pharmacy managers receive discounts from manufacturers for formulary placement, it is not known how much CVS Caremark pays for these drugs.

A Bristol-Myers Squibb spokesperson wrote in an email that, in addition to returning to the CVS Caremark Commercial Formulary, Eliquis will receive a priority appeal from CVS Health Zinc’s purchasing organization starting July 1st. Group buying organizations serve as discount aggregators for other PBMs.

A few months after CVS Caremark announced it was removing Eliquis from its formulary, Bristol-Myers Squibb launched a co-payment card that allowed some commercially insured patients, including those insured by CVS Caremark, to buy the drug for $10 a month.

But because these drugs are so widely prescribed, not every doctor was aware of the option, so access remained limited, said Dr. Geoffrey Barnes, a cardiologist and professor at the University of Michigan. Barnes, a consultant for both Bristol-Myers Squibb and Johnson & Johnson-owned Janssen Pharmaceutcal, discussed the impact of removing CVS Caremark from the formulary with CVS Health executives, he said.

“There is a broader conversation about drug costs in general and how we keep them under control so that they are affordable for all patients,” Barnes said. “This is something that is controlled not only by insurers or PBMs, but also by manufacturers. It’s a difficult problem.”

According to Antonio Ciaccia, CEO of drug pricing research firm 46brooklyn Research and president of consulting firm 3 Axis Advisors, pharmacy benefit managers typically don’t reverse prescription decisions or change coverage options mid-year. “It shows you that an active, angry and vocal group of patients can influence PBM decisions that work against their wellbeing,” he said.

Patient and protective Beth Joyner Waldron of Chapel Hill, North Carolina, has openly criticized the CVS Caremark change. Although her employer reinstated Eliquis on its drug list in February, Joyner Waldron, 52, continued to maintain public pressure on CVS Health and its executives on social media and believes patient activism has led to a change in the company. “It was an example of collective action,” she said.

The formulary change will go into effect one month after the Federal Trade Commission announced an investigation into the business practices of pharmacy benefit managers. Regulatory authorities will require CVS Caremark and the other five major PBMs to disclose information about their activities in order to assess how their activities affect drug pricing and availability.

CVS Caremark, Cigna Express Scripts and OptumRx UnitedHealth Group jointly control about 80% of the PBM market, according to the FTC.

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