The best way to join the Express Scripts formulary is to demonstrate that the proposed drug offers patients a greater benefit and is lower or competitive in cost compared to older drugs, reports FiercePharma. Drug manufacturers that want the pharmacy benefit manager to include their products in the formulary are communicating with the manager earlier in the process, to make sure their products are accessible and affordable. Express Scripts rejects higher-priced products that do not offer superior clinical benefits.
Express Scripts develops its formularies using physicians to evaluate clinical data, to decide which newer drugs are more effective than the older ones, and to compare product costs, explains FiercePharma. The development process involves a therapeutic assessment committee, a national pharmacy and therapeutics committee, and a value assessment committee, according to Express Scripts. The national pharmacy and therapeutics committee has 15 independent physician members and one pharmacist member. The committee members represent a variety of medical specialties, and all of the members have active community and academic-based practices.
The Express Scripts 2016 formulary includes Breo, a new respiratory medication by GlaxoSmithKline, and Zohydro, a pain medication. The pharmacy benefits manager had denied both medications placement on the 2015 formulary. Express Scripts also added Trajenta, a diabetes treatment by Eli Lilly and Boehringer Ingelheim, to its 2016 formulary after excluding it from the 2015 list, notes FiercePharma.