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The Booming Business Of Drug Exclusions

 
• By Jessica Merrill

The number of drugs included on formulary exclusion lists in the US has surpassed more than 400 at the top three PBMs, representing dramatic growth from just five years ago. Express Scripts recently revealed its 2022 exclusions.

Excluded sign
Formulary drug exclusion lists have grown significantly • Source: Alamy

Drug exclusion lists have become a valuable tool for payers to restrict access to drugs or to extract higher rebates from pharmaceutical manufacturers. The number of drugs excluded from formularies by each of the top three pharmaceutical benefit managers (PBMs) – CVS Caremark, Cigna Corp.'s Express Scripts and UnitedHealth Group's OptumRx – exceeded 400 in 2021, representing a substantial change to the way PBMs leverage formulary access to negotiate with drug makers compared to just five years ago.

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