Express Scripts Formulary Update

National Preferred Formulary Update: 2019 Status Changes

One principal guides our formulary development process: offering clinically effective medications that provide the greatest clinical value at the lowest net cost. Because of our partnerships with plan sponsors like you, the National Preferred Formulary (NPF) represents 25 million Americans. We are able to use our collective scale to negotiate with pharmaceutical manufacturers, pushing them to provide competitive pricing.

Summary of 2019 changes

Beginning Jan. 1, 2019, the changes below will go into effect for your member population. The 2019 NPF will exclude 48 additional drugs and prefer lower-cost alternatives. Based on an analysis of our book of business, the new exclusions will deliver an additional $3.2 billion in client savings in 2019, and only impact 0.2% of NPF members.

A new opportunity to control specialty spend

Of the 48 new exclusions, 11 are specialty products. Increased competition in the specialty space has allowed us to exclude drugs that have lower-cost alternatives. In the hepatitis C class, for example, the 2019 NPF will prefer Zepatier, the lowest cost hepatitis C product on the market. At the same time, member impact within specialty will continue to remain low.

The list of new exclusions is available here. The full list of exclusions will be available on Sept. 5, 2018.

Comprehensive communication plan

Our communication plan targets impacted members, ensuring a smooth experience. Beginning this fall, members will receive personalized notifications, reminder communications and targeted alerts about preferred options.

We will notify physicians and pharmacists of the upcoming formulary changes this fall. I can also provide member, physician and pharmacist notification timelines, as well as information you can include in communications to your population.