CVS Caremark Drug List Changes – Removal from Formulary – Rationale Effective January 2014
Note: This document is specific to the removal of drugs from the standard formulary for January 2014. This document does not address other drug list changes that are focused on non-preferred/preferred status changes.
Changes will be made to the CVS Caremark standard formulary effective January 1, 2014. The safety and efficacy of the medications on the formulary are among the most important consideration. Once safety and efficacy are established, the cost of the medication to our clients and their plan members is carefully considered. This document details the changes made to our standard template formularies Overview of Drug Removals Effective January 1, 2014 Additional Drug Removals Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Allergies flunisolide spray, fluticasone spray, triamcinolone Nasal Steroids Allergies flunisolide spray, fluticasone spray, triamcinolone Nasal Steroids spray, orNASONEXWITH azelastine, ASTEPRO or, Combinations Allergies azelastine, cromolyn sodium, PATADAY, PATANOL
Ophthalmic Anti-infectives Antivirals, Herpes Agents Asthma Beta-agonists, Short-Acting Asthma Steroid Inhalants Asthma/COPD Steroid/Beta Agonist Combination Cardiovascular atorvastatin, fluvastatin, lovastatin, pravastatin, Antilipemics * simvastatin, CRESTOR, SIMCOR, VYTORIN
HMG Co-A Reductase Inhibitors (HMGs or Statins)/Combinations Cardiovascular fenofibrate, fenofibric acid, ANTARA, LIPOFEN
Antilipemics * Fibrates
Page 1 of 11 Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
COPD Anticholinergics Diabetes Dipeptidyl Peptidase-4 (DPP-4) Inhibitors Diabetes Dipeptidyl Peptidase-4 (DPP-4) Inhibitor / Combinations Diabetes Insulin Sensitizers Diabetes ACCU-CHEK STRIPS AND KITS, ONETOUCH Supplies Strips and Kits Gastrointestinal Agents
lansoprazole del-rel, omeprazole del-rel, omeprazole-
Proton Pump Inhibitors
sodium bicarbonate, pantoprazole del-rel, DEXILANT,
High Blood Pressure candesartan-hydrochlorothiazide, irbesartan-Angiotensin II Receptor hydrochlorothiazide, losartan-hydrochlorothiazide, Antagonist/Diuretic valsartan-hydrochlorothiazide, BENICAR HCT,
Combinations Hematologic Platelet Aggregation Inhibitor Inflammatory Bowel Disease, ASACOL HD balsalazide, sulfasalazine, sulfasalazine delayed-rel,
Ulcerative Colitis Aminosalicylates Opioid Dependence Agents buprenorphine/naloxone sublingual tablets, Zubsolv Pain and Inflammation dexamethasone, methylprednisolone, prednisone Corticosteroids
The listed formulary considerations are subject to change.
Page 2 of 11 Overall Rationale for Removal of Drugs Within our Standard Formulary Management Approach While a formulary has many purposes, the main functions are: 1) To help plans manage drug spend through the appropriate use and selection of drug
2) To allow PBMs to negotiate with drug manufacturers for the lowest net cost for formulary
brand products, which helps plan sponsors manage their spend
Based on this, our formulary is evaluated on a regular basis to reflect changes in medical prescribing patterns, new drug products, and to help ensure CVS Caremark is delivering financial value to our clients and their members. Our continuous review process has led to the removal of drugs from our standard formulary. This document represents changes effective January 1, 2014. The following were key factors in the decision to remove certain drugs from the formulary:
• Deliver further savings to our clients and their members
o Managing pharmacy trend is a primary objective of our clients; our formulary is a key
element we can use to help our clients achieve their trend goals
o Removed drugs are higher-cost products within drug classes that offer multiple lower-
cost generic and/or brand alternatives; some removed products are available generically
• Maintain a clinically robust formulary that provides appropriate drug options
o Most drug classes now have multiple generic and lower-cost brand options that cover
the same indications as more costly options in the same class; the generic and lower-cost brand options offer similar efficacy and safety
o CVS Caremark provides an effective method for managing unnecessary utilization of
newly launched brand products that do not provide a clinical and/or financial advantage to our clients
o As the drug removal overview demonstrates, our standard formulary approach continues
to provide alternative drugs in each class that provide greater value to plan sponsors than the products removed from that class
Page 3 of 11 Drug Class-Specific Rationale Allergies, Nasal Steroids and Nasal Steroid Combinations
Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Allergies flunisolide spray, fluticasone spray, triamcinolone Nasal Steroids Allergies flunisolide spray, fluticasone spray, triamcinolone Nasal Steroids spray, orNASONEXWITH azelastine or ASTEPRO Combinations
General Clinical Notes: Therapeutically interchangeable class with generic agents available. Available brand agents have not demonstrated any clinical advantage over the available generic agents. Formulary alternatives cover all indications of the removed drugs. Generic triamcinolone and brand Nasonex are indicated for use in patients as young as two years of age. Class is currently at 80 percent GDR. Previous Strategy Alignment: Class was part of the previous formulary drug removals and has been part of our Generic Step Therapy Program offering. Other Notes: Rhinocort Aqua is the only Pregnancy Category B drug in this class. There are other allergy treatment options with category B ratings, such as OTC loratadine. Allergies, Ophthalmic Anti-Allergics
Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Allergies azelastine, cromolyn sodium, PATADAY, PATANOL
Ophthalmic General Clinical Notes: No clinically relevant differences in efficacy or administration, though dosing frequency varies. Therapeutically interchangeable class with generic agents available. Previous Strategy Alignment: None
Page 4 of 11 Anti-Infective, Antivirals
Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Anti-infective Antivirals General Clinical Notes: Generic equivalent (valacyclovir) available. Previous Strategy Alignment: None Asthma, Short-Acting Beta-Agonists
Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Asthma Beta-agonists, Short-Acting
General Clinical Notes: Therapeutically interchangeable class; same molecular entity (albuterol). Previous Strategy Alignment: Class was part of previous formulary drug removals and has been part of our Generic Step Therapy Program. Other Notes: Since Maxair contains chloroflurocarbons (CFCs), it will be removed from the market and cannot be made or sold after December 31, 2013.
Page 5 of 11 Asthma, Inhaled Steroids and Inhaled Steroid/Beta-Agonist Combination
Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Asthma Steroid Inhalants Asthma Steroid/Beta Agonist Combination
General Clinical Notes: Inhaled corticosteroids are therapeutically interchangeable at equipotent doses. Breo (fluticasone furoate/vilanterol) is only indicated for chronic obstructive pulmonary disease (COPD), while Advair (fluticasone propionate/salmeterol) and Symbicort (budesonide/formoterol) are indicated for COPD and asthma. Previous Strategy Alignment: None Cardiovascular, Antilipemics, HMG Co-A Reductase Inhibitors (HMGs or Statins)/Combinations Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
High Cholesterol atorvastatin, fluvastatin, lovastatin, pravastatin, HMG Co-A Reductase Inhibitors (HMGs or Statins) High Cholesterol atorvastatin, fluvastatin, lovastatin, pravastatin, HMG Co-A Reductase Inhibitors (Combinations
General Clinical Notes: Lipitor has a generic equivalent available (atorvastatin). Generic statins are available, including high potency agents (e.g., atorvastatin). Vytorin (simvastatin/ezetimibe) is available as a preferred combination product. HMG class GDR is 86 percent. The addition of ezetimibe to a statin has not demonstrated reduction in cardiovascular events. Previous Strategy Alignment: Class was part of previous formulary removal changes and has been part of our Generic Step Therapy Program.
Page 6 of 11 Cardiovascular, Antilipemics, Fibrates Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
High Cholesterol Fibrates
General Clinical Notes: Generic equivalent available (fenofibrate). Previous Strategy Alignment: Class has been part of our GSTP offering. COPD, Anticholinergics
Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
COPD Anticholinergics
General Clinical Notes: Both Tudorza Pressair and Spiriva are indicated for the maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease. Spiriva (tiotropium) is also indicated for the reduction of exacerbations of chronic obstructive pulmonary disease. Spiriva is administered once daily, has more indications than the other agents, and has significant data supporting its use. Previous Strategy Alignment: None
Page 7 of 11 Diabetes, Dipeptidyl Peptidase-4 (DDP-4) Inhibitors, DDP-4 Inhibitor/Biguanide Combinations, and DDP-4 Inhibitor/Thiazolidinedione Combinations Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Diabetes Dipeptidyl Peptidase-4 (DPP-4) Inhibitors Diabetes Dipeptidyl Peptidase-4 (DPP-4) Inhibitor / Combinations General Clinical Notes: Therapeutically interchangeable class. The only available thiazolidinedione, pioglitazone, is available generically. Previous Strategy Alignment: Class was part of previous formulary drug removals. Diabetes, Thiazolidinediones
Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Diabetes Thiazolidinediones
General Clinical Notes: Generic equivalent (pioglitazone) available. Previous Strategy Alignment: None.
Page 8 of 11 Diabetes, Kits and Test Strips
Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Diabetes ACCU-CHEK STRIPS AND KITS, ONETOUCH STRIPS AND KITSSupplies
General Clinical Notes: No clinical concerns between diabetic test strips. Members can obtain a free diabetic meter through our free meter program as long as the member meets meter program criteria. Previous Strategy Alignment: Kits and test strips were part of previous formulary drug removals (Freestyle). Gastrointestinal, Proton Pump Inhibitors
Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Gastrointestinal
lansoprazole del-rel, omeprazole del-rel, omeprazole-
Proton Pump Inhibitors
sodium bicarbonate, pantoprazole del-rel, DEXILANT, NEXIUM
General Clinical Notes: Generic equivalents (lansoprazole delayed release [DR] and pantoprazole DR) available (except for Protonix Granules). Previous Strategy Alignment: Class has been part of our Generic Step Therapy Program.
Page 9 of 11 High Blood Pressure, Angiotensin II Receptor Antagonists/Diuretic Combinations Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
High Blood Pressure candesartan-hydrochlorothiazide, irbesartan-Angiotensin II Receptor hydrochlorothiazide, losartan-hydrochlorothiazide, Antagonist / Diuretic valsartan-hydrochlorothiazide, BENICAR HCT,
Combinations
General Clinical Notes: Generic equivalent available (valsartan-hctz). In addition, therapeutically interchangeable class with other generics also available. Previous Strategy Alignment: Class was part of previous formulary removal changes and has been part of our GSTP offering. Hematologic, Platelet Aggregation Inhibitors Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Platelet Aggregation Inhibitors
General Clinical Notes: Generic equivalent available (clopidogrel). Previous Strategy Alignment: None Inflammatory Bowel Disease Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Inflammatory Bowel Disease balsalazide, sulfasalazine, sulfasalazine delayed-rel,
(IBD), Ulcerative Colitis * Aminosalicylates
General Clinical Notes: No clinically relevant differences in safety, efficacy or administration, though dosing frequency varies. Oral agents for inflammatory bowel disease act on different locations in the bowel and are not bioequivalent. However, the clinical relevance of such differences is not clear.
Previous Strategy Alignment: None
Page 10 of 11 Opioid Dependence Agents Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Opioid Dependence Agents buprenorphine/naloxone sublingual tablets General Clinical Notes: Different formulation (buprenorphine/naloxone SL tablets) generically available. Brand formulation is a film, while the generic version is a sublingual tablet. Previous Strategy Alignment: None Other Notes: The generic SL formulation is available in 2mg/0.5mg and 8mg/2mg strengths and became available as a generic March 2013. We would expect pricing to drop for the generic version after the 180 day exclusivity expires. The removed Suboxone Film is available in 2mg/0.5mg, 4mg/1.0mg, 8mg/2mg, and 12mg/3mg strengths. Pain and Inflammation, Corticosteroid Agents Category Drug Removed Formulary Considerations Drug Class from Formulary Listed for reference, as of June 24, 2013. Final list of alternatives
may change as other formulary changes (e.g., preferred status) and
Pain and Inflammation dexamethasone, methylprednisolone, prednisoneCorticosteroids
General Clinical Notes: Therapeutically interchangeable class when used at equipotent doses with generics available. No clinically relevant differences in safety or efficacy, though dosing administration, frequency, and timing vary. Rayos is a delayed-release formulation, while the generics are immediate-release agents.
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WORKSHOP ON CURRENT SCENARIO OF RODENTICIDES AND ABSTRACT Rodents are estimated to cause about 5-15% damage and loss to cereals and other sectors. There is no place/trade or business that is not afflicted with rodents. They cause accidents by damaging electrical/ cable installations. The total damage due to rodents is huge and runs into thousands of crores in the country. Rodenticides a
CVS Caremark 
Category 
Anti-Infective, Antivirals 
Asthma, Inhaled Steroids and Inhaled Steroid/Beta-Agonist Combination 
Cardiovascular, Antilipemics, Fibrates 
Diabetes, Dipeptidyl Peptidase-4 (DDP-4) Inhibitors, 
Diabetes, Kits and Test Strips 
High Blood Pressure, Angiotensin II Receptor Antagonists/Diuretic Combinations 
Opioid Dependence Agents