CVS Caremark to Reverse Change to DOAC Formulary Classification

CVS Caremark has informed the ACC that due to a significant reduction in manufacturer pricing the pharmacy benefits manager will return to apixaban as a preferred product within the direct oral anticoagulants (DOACs) classification effective July 1.

Since January 2022, CVS Caremark has required patients on apixaban to switch to rivaroxaban or request a formulary exception. As of July 1, these patients will have access to apixaban without the need for requesting an exception. CVS Caremark will be sending follow-up letters to patients who were impacted.

Last year, the ACC and the American Society of Hematology (ASH) engaged with CVS Caremark over this change to convey concerns of its potential impact on patients and practice staff. ACC and ASH also provided CVS Caremark with specific clinical scenarios where exceptions should be approved. During subsequent meetings, ACC and ASH communicated examples of 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.

Access to effective cardiovascular medications is vital for optimal patient care. Although the ACC disagrees with a strategy of excluding clinically proven medications from formularies based on cost alone, we applaud CVS Caremark on their efforts to reduce health care spending as a result of their effective negotiations with drug manufacturers,” said ACC President Edward T. A. Fry, MD, FACC. “It is clear that the price of DOAC therapy and the out-of-pocket cost to patients needs continued attention to ensure equitable and affordable access to therapies that ultimately improve clinical outcomes and reduce overall long-term health care costs.

Moving forward after July 1, for CVS Caremark patients that are currently on rivaroxaban, but need to switch to apixaban, there should be an active prescription for apixaban.

Clinical Topics: Anticoagulation Management, Cardiovascular Care Team

Keywords: Costs and Cost Analysis, Pharmacy, Hematology, Prescriptions, Anticoagulants, Workload, Follow-Up Studies, Rivaroxaban, ACC Advocacy

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