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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, or NASONEX WITH 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, or NASONEX WITH 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 KITS Supplies

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, prednisone Corticosteroids

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.

Previous Strategy Alignment: None
Page 11 of 11

Source: http://www.mercerhrs.com/microsite/harpercollins/oe/pdf/CVS_Caremark_Drug_List_Changes.pdf