TOLL FREE - 800-294-6324 TDD TOLL FREE - 800-863-5488 Caremark Connect Specialty Pharmacy TOLL FREE - 800-237-2767 Print Your Caremark ID Card Instructions. Adderall XR, Concerta and Advair will be the first three drugs in this new program.All patients utilizing those medications will be transitioned to the brand-name drugs at the beginning of the year. CVS Caremark ® Performance Drug List - Standard Control for Clients with Advanced Control Specialty Formulary ® is a guide within select therapeutic categories for clients, plan members and health care providers. Pharmacy benefit biosimilar drugs are not here yet, so PBMs have focused on provider-administered drugs. While we don’t expect any negative clinical impact on members, the use of the biosimilars will be assessed and monitored by the physicians administering the drugs. Impacted members will be required to obtain a new system based on the preferred formulary product, which may include a handheld reader, receiver or application on their smart device, as well as compatible sensors and applicators.

While members will benefit from the Tier 1 copay, it is unclear if plan designs for all plan sponsors can support generic copays for brand-name drugs. This move will allow coverage of a brand drug on the first tier if the brand is the lowest-net-cost option.

For example, the multiple sclerosis category for 2020 distinguishes between two types of agents: Express Scripts will prefer Zarxio and Nivestym, the biosimilars for Neupogen, instead of Granix, but will exclude coverage of Fulphila, a biosimilar for Neulasta. For a list of the drugs and products that are not covered under the Citigroup Prescription Drug Program, as well as a list of covered alternatives for select medications, see the 2020 CVS Caremark Preferred Drug List Exclusions at Citibenefits.com. A few innovative strategies we will see implemented next year include a flex formulary for Express Scripts, a brand-over-generic strategy for CVS, and variations in coverage for biosimilars, hyperinflationary drugs, and continuous glucose monitors.The findings of an impact analysis across our book of business suggest Want to find out how these changes may affect you? CVS’ approach of giving equal status to both the biosimilar and brand drug Neulasta will allow coverage for both and utilization of the biosimilar should physicians and members so choose.Hyperinflationary drugs Duexis (ibuprofen + Pepcid) and Vimovo (naproxen + Nexium) continue to be covered on the National Preferred Formulary for Express Scripts but excluded from the National Preferred Flex Formulary. The hepatitis C formulary situation highlights the warped incentives of today’s drug channel. Clinically, we expect these changes to have little to no impact on members.FreeStyle Libre, the continuous glucose monitor (CGM) with the lowest upfront price point, is being removed from the CVS Standard Control Formulary and replaced with the high cost CGM, Dexcom G6, as the preferred agent.

CVS Caremark excluded specific ANDA generic NDCs for benzonatate, butalbital-APAP, chlor-zoxazone 250 mg, diclofenac sodium gel 1%, and Diclofex DC. WEBSITE.

Similarly, OptumRx Premium Formulary will exclude FreeStyle Libre and move Dexcom G6 to the preferred position, making this formulary strategy completely reliant on rebates to make up for any plan paid differences in costs.

Due to differences in price, members with a cost-share or deductible may notice a higher out-of-pocket amount for the Dexcom G6.PSG has developed a review of each of the Big Three PBMs and is providing insights into the changes plan sponsors can expect in 2020. 2020 Caremark Prescription Drug. If you would like more information on another PBM not represented here, please contact us at Renee Rayburg helps lead Artemetrx services in Clinical Consulting with more than 23 years in pharmacy and medical benefit management to support our health plan sponsors, providers, and patients. The chart below shows our count of the number of drugs that have been excluded from the national preferred formularies of the two largest PBMs: CVS Health and Express Scripts.