Express Scripts Makes LifeScan the Preferred Meter, Test Strips for People With Diabetes

LifeScan, the diabetes division that Johnson & Johnson shed after ending US sales of its Animas insulin pump, will be the sole preferred provider of meters and testing strips for Express Scripts members in 2019.

In June, Johnson & Johnson accepted the $2 billion offer from Platinum Equity for its diabetes unit but said it would arrange for a smooth transition. Today, Express Scripts announced that all other brands of meters and test strips will be excluded from its National Preferred Formulary (NPF) in 2019.

That includes Abbott, even though the company’s Freestyle Libre flash continuous glucose monitoring (CGM) system, which recently received FDA approval for a 14-day sensor, will remain on the “nonpreferred” list in 2019. The CGM product is “not considered a traditional meter/strip,” according to an Express Scripts spokeswoman.

The 2019 NPF includes 48 new formulary exclusions, allowing access to 3886 drugs for its 25 million members. Express Scripts said 22 newly excluded drugs had low-cost generic alternatives, and that “even when brand drugs include rebates,” the generics offer better value.

Click here to read more about other exclusive coverage deals in diabetes.

Express Scripts touted its NPF as a way to drive members to lower-cost medications, which the pharmacy benefit manager (PBM) said has saved health plans $10.6 billion since 2014 and will save them $3.2 billion in 2019.

PBMs have been under fire over the past year as the Trump administration seeks to rein in what consumers pay out of pocket for prescription drugs. Pharmaceutical companies point to the system of rebates that are paid to maintain position on formulary as the culprit behind escalating prices. PBMs have countered that list prices are too high, and others point to changes in benefit design that require most cost sharing from consumers.

“High drug prices are one reason that the US spends more per capita on healthcare than any other developed nation. For far too long, drugmakers have been charging whatever the market will bear for medications, including drugs that do not provide any additional clinical value for patients,” said Steve Miller, MD, chief medical officer, Express Scripts.

“Formularies such as our National Preferred Formulary, which drives out waste and gives preference to medications with lower prices and high value, can help Americans save significantly on their healthcare costs without sacrificing quality or care.”

Rising prevalence of diabetes and obesity—and the number of therapies to treat both—makes this an active area of formulary management. According to the American Diabetes Association, 30 million people in the United States have diabetes, and all but about 1.25 million have type 2 diabetes. The CDC estimates that 93 million Americans are obese.

A report Express Scripts released today said that the NPF has reduced the average diabetes prescription cost 36% from 2016 to 2018. Aggressive treatment of diabetes with newer therapies is associated with a decline in hospitalization, especially if patients can avoid hypoglycemia.

For example, a study released this week in Health Affairs found that states that expanded Medicaid in 2014 saw a sharp rise in fills of diabetes prescriptions, including more of the newer, more expensive prescriptions such as sodium glucose co-transporter-2 inhibitors and glucagon peptide-1 (GLP-1) receptor agonists. These states saw drops in hospitalizations associated with diabetes.

According to an Express Scripts spokeswoman, although requirements for utilization management and step therapy vary by plan, there are no changes to the NPF for 2019 for insulin or other diabetes therapies.

Preferred diabetes therapies are:

• dipeptidyl petptidase-4 inhibitors: sitagliptin (Januvia), linagliptin (Tradjenta), sitagliptin/metformin (Janumet), sitagliptin/metformin extended release (Janumet XR), and linagliptin/metformin extended release (Jentadueto XR)
• GLP-1 receptor agonists: exenatide extended release (Bydureon), exenatide (Byetta), dulaglutide (Trulicity), and semaglutide (Ozempic)
• insulins: Humulin and Humalog

Express Scripts’ report spells out how physicians can request an exception if a patient needs a drug that is not on the preferred formulary, but says that this affects less than 1% of members each year. Patients who have started on a drug that becomes excluded can be grandfathered.

The report does not say whether a similar policy applies to diabetes supplies. It remains to be seen what effect Express Scripts’ move has on the diabetes test strip market. Patients, advocates, and researchers found that a competitive bidding program in Medicare drove down prices and lacked quality controls, resulting in test strips that were inaccurate and harmful for patients. Previous exclusive arrangements have pushed diabetes suppliers out of the market altogether—something that happened to Johnson & Johnson just last year.

After the national health insurer UnitedHealthcare entered into an exclusive arrangement with the insulin pump manufacturer Medtronic, Johnson & Johnson announced in October 2017 it would cease sales of its Animas Vibe and OneTouch Ping pumps in the United States and Canada.

Reference

Myerson R, Lu T, Tonnu-Mihara I, Huang ES. Medicaid eligibility expansions may address gaps in access to diabetes medications. Health Aff (Millwood). 2018;37(8):1200-1207. doi: 10.1377/hlthaff.2018.0154.