• by Thom Forbes  @tforbes, August 7, 2015

The headlines belong to Pfizer’s Viagra but CVS/Caremark said yesterday that it is removing more than two dozen additional prescription drugs from its formulary — the list of medications it provides at a steep discount to consumers covered by the health insurance with which it is allied — starting Jan. 1. 

“What a letdown,” writes Alisa Chazen in her lede for the New York Daily News. “Scores of men stand to lose their little blue pills…. Affected men looking for an edge in the bedroom will have to turn to Eli Lilly & Co.’s little yellow pills, Cialis, instead.”

Not entirely, as Chazen later explains. CVS drugstores will still stock Viagra and insurance plans using Express Scripts, CVS/Caremark’s larger competitor, will still cover it. Or flush devotees can pay full price.

Bloomberg’s Crayton Harrison broke the story about Viagra Wednesday with the observation that generic competitors are likely to hit the market in two years. He also pointed out that “employers and insurers who use CVS to manage their drug benefits can also choose to make exceptions to the formulary.”

“Pfizer is committed to ensuring patient access to our medicines,” Pfizer spokesman Steve Danehy e-mailed Harrison. “Viagra continues to be available to millions of patients in the marketplace, including many patients whose pharmacy benefit is managed by Caremark.”

“This move comes as drugs hit an age of astronomical prices. Spending on prescription drugs last year reached a record-breaking $374 billion, up 13% from 2013, the largest percentage increase in more than a decade,” writes Trisha Thadani for USA Today.

The Wall Street Journal’s Peter Loftus views the decision as “the latest example of the tough tactics some health-care managers are using to control rising drug costs.” 

Sanford C. Bernstein analyst Geoffrey Porges “calls the coverage exclusions a ‘potent weapon’” for pharmacy benefit managers, Loftus writes. “In the past, PBMs wouldn’t typically exclude drugs from coverage. Instead, they’d try to direct patients to cheaper options by requiring them to pay more out-of-pocket for less-favored drugs. CVS first began excluding drugs from its preferred list in 2012, and Express Scripts later followed suit."

Despite the news, Pfizer’s stock was rated a “buy” by TheStreet Rating’s team with a score of A-, Tony Owusu reports, “based on the convergence of positive investment measures.”

CVS/Caremark’s “list of excluded drugs has ballooned from 34 to 124” from 2012 to 2016, reports David Goldman for CNN Money. “Similarly … rival Express-Scripts has banned 90 drugs from its coverage.”

“For those drugs that are removed, equally effective products with lower overall costs remain available,” CVS said in a statement, Goldman reports. “Since introducing our industry-leading and rigorous approach … in 2012, we have delivered significant savings for our plan sponsors.”

The CVS/Caremark formulary will also exclude Vivus’ weight-loss treatment Qsymia and “two interferon-based multiple sclerosis treatments from Biogen, big-selling Avonex and its new longer-acting Plegridy,” report Reuters’ Ransdell Pierson and Bill Berkrot. “Johnson & Johnson's two-year-old diabetes treatment, Invokana, and a related combination treatment called Invokamet, will also be stripped from CVS coverage.”

Diabetes Insider has a full list of the newly excluded drugs — from  Abilify, an antipsychotic, to Zubsolv, which is used to treat opioid dependence. Any generic versions of the medicines remain covered, Paola Celedonio points out. But “most of the people are not happy with the announcement as many don’t trust on taking generic versions of the medicines even though those comes at much cheaper prices.” 

Indeed, as Katie Thomas reported in the New York Times in 2013, researchers at Brigham and Women’s Hospital in Boston surveyed more than 1,000 patients about their views on generic drugs in 2007. Although they “agreed overwhelmingly that generics were ‘a better value’ than branded drugs, and fewer than 10 % believed that generic drugs caused more side effects,” only 37.6% preferred generics over brand-name drugs when it came to themselves.

“Patients’ and providers’ perceptions about the efficacy, safety, or value of generic drugs may be responsible for these inconsistencies,” the abstract for the study concluded.

Sounds like a clarion call for better marketing, no?