Novo Nordisk has once again been excluded from the extensive national list of preferred drugs from the US’ largest pharmacy benefits manager, Express Scripts, after both Victoza and Novolog were bumped from the list last year.

That much is clear after Express Scripts, which covers some 25 million Americans, and the somewhat smaller PBM, CVS Caremark, published their drug lists for 2015.

“In my opinion, there is a bigger difference between Victoza and Byetta/Bydureon, which has also been shown in clinical studies. In that light, Novo might have hoped that Victoza would have been re-included on Express Script’s list for 2015. One might have expected to see a push back from patients and doctors to have the better drug, Victoza, included again. But it is status quo,” Sydbank analyst, Søren Løntoft Hansen, tells MedWatch and adds about the CVS list:

“Taking a positive Novo-view on the matter, there’s a great focus on how big discounts companies are willing to offer on their drugs. In that light, it’s positive that Novo has managed to retain its position on CVS Caremark’s list, which, I believe, they won back in 2012.”

The discount game

Ritzau Finans has previously reported that Novo Nordisk estimates the exclusion of Novolog and Victoza from the Express Scripts list will cut about 1% of its annual sales. So it might seem surprising that Novo Nordisk has not been willing to play the discount game in order to secure the important contract.

“It’s simply about how willing you are to give discounts to these major purchasing organizations. It does not seem like Novo has been willing to compete on this parameter and jeopardize part of its earnings so far. It’s also worth noting, when looking at the CVS list on the new SGLT-2 drugs in diabetes, that Invocana has been included, while Farxiga hasn’t. It says something about the focus of these major contracts; that is, who is willing to offer the biggest discounts,” Søren Løntoft Hansen says, adding:

“But you might presume that Novo has been willing to offer some sort of discount to CVS Caremark that they haven’t been willing to give to Express Scripts. Express Scripts is a great deal bigger than CVS Caremark, so it’s quite possible that they have demanded a bigger discount.”

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 Novo Nordisk silent about the loss of massive contract 

- translated by Martin Havtorn Petersen

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