Express Scripts, the nation’s largest pharmacy benefits manager, will exclude an additional 64 medicines next year from its formulary – the list of drugs that get preferred insurance coverage. The company estimates that restricting access to the drugs will save health plans an extra $700 million.
Combined with earlier exclusions, the PBM estimates overall savings will reach $2.5 billion in 2018, which would represent a 39 percent increase over projected savings this year. All in all, the PBM plans to exclude 159 medicines out of more than 3,700 that will be available next year. PBMs, you may recall, are crucial, behind-the-scenes middleman that negotiate drug prices on behalf of health plans, unions, and government agencies.