Driving Drug Savings Through 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. Formularies 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”); and

An annual formulary review by the National P&T Committee.

The TAC and P&T Committee – which have no access to cost or financial information – have first and last word on formulary recommendations.

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.

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.

Read more about how medicines are priced

¹ Formularies | Express Scripts

² Ibid.