DRIVING DRUG SAVINGS THROUGH FORMULARIES
Express Scripts builds clinical-first formularies.
Industry-leading formularies = greater value
With more than 19,000 approved prescription drugs available in the U.S., formularies are lists of covered medications to help guide clients and customers to clinically sound, cost-effective medications.
Our prescription drug programs help ensure access to the most effective medications, drive competition among pharmaceutical companies, and help combat an estimated $16 billion wasted every year on low-value medications.
How we build well-designed formularies
Express Scripts builds formularies, or lists of covered medications, to provide clients with the most clinically sound, high-quality pharmaceutical products, which are updated as new medications come to market. Our clients can select a formulary that is most appropriate for their unique member needs, customize any formulary or develop their own. Express Scripts’ formulary development process is based on three principles:
1
Clinical appropriateness, safety and effectiveness of the drug—not cost— are the foremost considerations
2
The prescribing physician always makes the final decision regarding their patient’s drug therapy
3
Express Scripts develops clinically-sound formularies based on evaluations of independent physicians
Consistent with these principles, Express Scripts offers a variety of standard formularies, which are developed through a four-step process involving the work of distinct committees:
Therapeutic Assessment Committee (TAC)
National Pharmacy & Therapeutics (P&T) Committee
Value Assessment Committee (VAC)
An annual formulary review by the National P&T Committee
Every drug is given one of four designations, which will result in placement on or exclusion from Express Scripts formularies:
1. Include
Recommended for inclusion on all Express Scripts National Formularies
2. Optional
Formulary recommendations should be based on a value assessment by Express Scripts
3. Exclude
Drugs in this category should not be added
4. Access
Recommended for conditions where there is only one drug available—typically this includes a relatively small number of patients
The TAC and P&T Committee—which have no access to cost or financial information—have first and last word on formulary recommendations.
Express Scripts clients have secured cumulative savings of approximately $30 billion since 2014 from our formulary selections and strategies.1
A look at key Express Scripts formularies
Express Scripts’ largest standard formulary, the National Preferred Formulary (NPF), includes about 600 brand-name drugs and 99% of all generics. Based on the formulary review process, excluded drugs are less effective or safe than existing therapies—or lack sufficient clinical evidence for inclusion on Express Scripts formularies.
These exclusions account for a tiny percentage—about 3% of FDA-approved drugs were excluded in 20232—and enable Express Scripts to drive greater competition among pharmaceutical manufacturers and greater savings for clients who can pass those savings to patients.
A majority of Express Scripts clients design custom formularies based on their unique patient population.
More information about the Express Scripts formulary development process and clinical reviews can be found in our white paper on the subject.
