2021 National Preferred Formulary: Clinically Sound, Cost Effective

The National Preferred Formulary offers plan sponsors an affordable way to maintain benefits.

As the COVID-19 pandemic continues, many employers and other plan sponsors are grappling with difficult situations, choosing between maintaining employee benefits and avoiding staff and resource reductions. Utilizing the National Preferred Formulary (NPF) is a powerful, clinically sound way to drive savings.

Our partnership with thousands of plan sponsors enables us to use our collective scale to negotiate deeper discounts on the medications our members need. These prescription drug formularies preserve member choice by providing access to clinically effective – and cost-effective – generic and brand name drugs.

An independent panel of clinical experts that focuses first on clinical factors guides our unique approach to drug formulary management. We consider excluding a product only if there are proven, clinically comparable products available for members. Anyone with a clinical need for a medication that is not on our formulary has a clear pathway to have that drug covered by requesting an exception.

As part of our formulary management process, we are making changes to the NPF effective January 1, 2021. As a result of this update, 98.7% of members will not experience any changes. The small percentage who are affected will receive personalized communications educating them about their options, and we will notify their physicians and pharmacists before the exclusions are implemented.

Nearly 28 million Americans obtain their pharmacy benefit coverage through Express Scripts’ National formularies.


2021 NPF: Preserving Choice While Keeping Costs In Check

The National Preferred Formulary provides exceptional value for plan sponsors wishing to maximize member choice and access to clinical therapies.

Express Scripts’ commercial clients’ drug spend increased by only 2.3% in 2019, although brand drug prices increased by 5.2%. The NPF is one of the powerful tools that helped deliver these results.

To further drive urgently needed savings for plan sponsors while protecting choice and access to prescription drugs, we will remove 70 products from the NPF:

  • 45 single-source brands (products with therapeutic alternatives available on the formulary)
  • 25 multi-source brands (products that have lower-cost generic equivalents with the same active ingredient)

This formulary adjustment will drive additional value in some of the nation’s highest spend categories, including inflammatory conditions, diabetes, cardiovascular conditions, and asthma and other pulmonary conditions. In just seven years, the NPF has saved clients $19 billion in annual, incremental value.


Helping Patients Achieve Optimal Outcomes

Our goal is to make sure each patient gets the medicine that helps achieve the best outcome.

In addition to our member communications plan, our Academic Detailing pharmacists and Accredo® Physician Engagement team meet with prescribers to educate them on lower-cost alternatives and identify opportunities to reduce utilization. While these teams are normally dedicated to one client or one therapy class, in these extraordinary times, we’ve called on them to help ease the transition for members.

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