News and Insights
The Bar for Product Reimbursement Just Moved Higher
After seeing their products being rejected in recent years by reimbursement agencies overseas, pharmaceutical manufacturers are suffering the same fate in the U.S., as PBMs refuse to include a growing list of drugs on their formularies. The country’s largest PBM, Express Scripts, recently announced that 48 products, including a range of new and older drugs, will not be covered on the National Preferred Formulary for 2014. While this action is estimated to affect “a mere” 600,000 -800,000 patients, it will have a significant impact on certain products — especially those trying to establish themselves in the market. Established products will also take a hit, as evidenced by Novo Nordisk’s expectation that corporate earnings will be reduced by about 3% as a result of losing Express Scripts’ business for two of its largest drugs. Indications are that this trend will continue to grow and the barriers will get higher. CVS/Caremark, the second largest PBM in the U.S., has already said it will be adding to the 34 products it blocked last year.Read More
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