The American College of Cardiology and patient groups pushed the PBM to reverse its decision to take Eliquis off its formularies. CVS Caremark says it changed course after negotiating a lower net price.
After objections from patient groups and professional organizations, CVS Caremark has put Eliquis (apixaban) back on its formularies after removing the drug from its lists of covered drugs at the beginning of the year.
“This is about decisions between doctors and patients being respected,” said Beth Joyner Waldron, a patient advocate in North Carolina who has been critical of CVS Caremark. Referring to other patient groups and advocates, Waldron said, “This is testimony to the power of collective action.”
CVS Caremark issued a statement that said Eliquis was added back because it secured a lower net cost for patients from negotiations with the drug manufacturer. “Anticoagulant therapies are among the nonspecialty products where we are seeing the fastest cost increases from drug manufacturers, and we will continue to push back on unwarranted price increases,” said the statement.
A company spokesman said Eliquis was being added to CVS Caremark’s Value Formulary along with Standard and Advanced Controlled formularies. The change takes effect July 1.
Modern Healthcare reported the CVS Caremark formulary change on Wednesday.
Eliquis is in a class of drugs called direct oral anticoagulants (DOACs) that are taken by people to prevent blood clots. Other DOACs include Xarelto (rivaroxaban), Pradaxa (dabigatran), Savaysa (edoxaban), and Bevyxxa (betrixaban). For people with atrial fibrillation and other conditions that result in long-term clotting risk, the DOACs are now often prescribed instead of warfarin, the mainstay of anticoagulation for years, because the risk of bleeding is lower for patients taking DOACs rather than warfarin. Additionally, patients on DOACs don’t need to be monitored as closely as patients on warfarin.
Research published last year in JAMA Health Forum showed that Medicare Part D spending on DOACs had increased 16-fold from 2011 to 2019, and that in 2019, Part D spending on DOACs reached $7.23 billion. Bristol-Myers Squibb reported in its 2021 annual report that Eliquis generated $10.76 billion last year, $6.45 billions of which were sales in the United States.
Waldron, who was diagnosed with venous thromboembolism about 20 years ago, has been taking Eliquis for eight years. She is insured by the North Carolina State Health Plan, which covers the state’s teachers and state employees. She says patient advocacy groups started to hear about Eliquis being dropped by CVS Caremark in October 2021 and that she received a letter as a member of the North Carolina State Health Plan about the formulary change in November 2021. She says she managed to stay on the drug for a combination of reasons: She had a large supply on hand, she got a copay card from the manufacturer, and a decision the North Carolina State Health Plan to put the drug back on the formulary for its members.
The American College of Cardiology (ACC)and the American Society of Hematology have been involved in pushing back on CVS Caremark’s formulary decision. In January 2022, the ACC posted a news story on its website that said the group, along with the American Society of Hematology, had met with CVS Caremark about its decision to prefer Xarelto — the article on the website uses the generic name, rivaroxaban — over DOACs on its formularies. The ACC article says that CVS Caremarrk pointed to medical specialty guidelines, including atrial fibrillation guidelines issued jointly by the ACC, the American Society of Hematology and Heart Rhythm Society in 2019, as justifying the decision to drop Eliquis off of its formularies. But the ACC article says the 2019 guidelines do not tier DOACs and their intent was to “encourage discussion between physicians and patients so an informed decision on the most appropriate medication can be made based on medical history and preferences.”
The ACC published a news story on Wednesday about CVS Caremark putting Eliquis back on its formularies. The article says that ACC and American Society of Hematology “engaged” with CVS Caremark about taking Eliquis off its formularies and "the potential impact on patients and practice staff.”
The ACC article says that the ACC and the American Society of Hematology told CVS Caremark about the “real-world implications on patients and additional workloads for medical practices related to medication approvals, as well as the vital need for the selection of medications to be left to the patients and clinicians.”
Waldron said she knows of eight events in five states that are related to people losing coverage of Eliquis because of the CVS Caremark change. Waldron said some of the events may be the result of gaps in anticoagulation therapy, adding that it would take research to determine the link between the events to CVS formulary decision.
Waldron said Bristol-Myers Squibb representatives have told patient groups that CVS Caremark would be reversing its decision and putting Eliquis back on its formulary. “I am very relieved that Caremark has finally acknowledged it,” she said.
Waldron has filed a complaint that two phone calls she received earlier this year from CVS Health, the parent company of CVS Caremark, constituted a violation of the Health Insurance Portability and Accountability Act (HIPAA). According to Waldron, the calls indicated that someone at the company had inappropriately shared information from her medical records.