CVS Health Excludes 35 Products for 2017

CVS Health says it will remove 35 products from its standard formulary for 2017, including drugs treating cancer and diabetes. The pharmacy benefit manager (PBM) said it eliminated 10 products because they were “hyperinflationary.” Among the replacements: Amgen’s Neupogen, a bone marrow stimulant, will be removed in favor of Sandoz’s biosimilar Zarxio, and Sanofi’s Lantus, an insulin injection, will be replaced by Eli Lilly’s biosimilar Basaglar. CVS Health is touting the move as a cost-saving measure that will trickle down to clients and members. However, pharmaceutical companies and stakeholders see the decision as a detriment to patients, denying them the opportunity to take branded products that may work better than biosimilars. Patient advocates have expressed concern about a possible trend in “nonmedical switching” from branded drugs to biosimilars. Nonmedical switching occurs when a patient moves from an effective treatment to an alternative solely as a cost-cutting measure. CVS says it plans to evaluate medications quarterly for its formulary and will focus on those it believes have “egregious cost inflation.” Fellow PBM Express Scripts has also announced product exclusions, including Valeant Pharmaceuticals’ Zyclara and Eli Lilly’s Taltz.

Insurers Request Expedited Trials on Merger Deals

Anthem, Cigna, Aetna, and Humana have expressed impatience over the pace at which the US Department of Justice (DOJ) is initiating the companies’ merger trials. The DOJ is still debating whether to try the Aetna-Humana and Anthem-Cigna cases separately and how soon the proceedings should begin. All 4 companies have requested a court date before the beginning of 2017, and Anthem claims that 4 states have halted their review of the potential merger with Cigna pending the DOJ lawsuit’s outcome. The DOJ replied to these requests by stating that a February 17, 2017, court date for both cases would be plausible, but challenging. Anthem’s lawyers have been vocal in their opposition to a joint trial; they have argued that the mergers would bolster the public exchanges by increasing competition and allowing the companies to increase their exchange presence. The DOJ, however, asserts that these mergers would reduce competition in multiple markets, including the Medicare Advantage market.

Allergan and Merck Eyeing Biogen for Possible Acquisition

Merck and Allergan are among the companies reportedly holding informal discussions on possibly acquiring Biogen. While Biogen has not expressed interest in selling, the company has faced some setbacks over the last year that could make a buyout an attractive option. The company has dealt with competition from new multiple sclerosis (MS) drugs that may overshadow Biogen’s Tecfidera, as well as portfolio changes and the impending departure of CEO George Scangos. Allergan is seeking new acquisition opportunities after a failed attempt to merge with Pfizer, and Merck may be looking to expand into the MS market. If Biogen were to be acquired—at an expected cost of around $72 billion—it would likely be by one of the larger pharmaceutical companies.

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