Below is an excerpt from an article posted on ModernHealth.com. A link to the full article on their page appears at the end of the excerpt.
For eight years, Beth Joyner Waldron has counted on Eliquis to treat clots in her lungs and legs.
In November 2021, she received a letter from CVS Caremark telling her the pharmacy benefit manager is excluding Eliquis from its formulary next year. Receiving the letter made her emotional.
Just a year ago, her father bled to death. Joyner Waldron said he had an adverse reaction to his blood thinner.
“I nearly died from my blood clots 18 years ago and I know from my dad’s experience the treatment carries a high risk,” Joyner Waldron said. “I’ve been stable, I’ve not had any bleeds, and then I get this letter saying I have to switch meds, that obviously induces anxiety.”
She also was angry that the letter did not include information on how to appeal the decision.
As of January 1, one of the nation’s largest pharmacy benefit managers no longer covers a blood thinner that Joyner Waldron and an estimated 3 million others rely on to prevent and treat blood clots. Just five weeks before the formulary change was made, CVS’ $39 billion Caremark subsidiary sent letters to its commercial enrollees, alerting them that they would need to switch from Bristol-Myers Squibb’s Eliquis to Janssen Pharmaceuticals’ Xarelto, both anticoagulants that experts say have never been proved to be interchangeable through randomized control trials.
To read the rest of this article, please visit the site where this article originally appeared: https://www.modernhealthcare.com/patient-care/cvs-adds-more-vital-drugs-formulary-exclusions
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Dr. John Vazquez is a Physician Consultant with TPG International Health Academy (TPG-IHA). TPG-IHA has hosted educational programs for senior healthcare executives for 25+ years, holding week-long Educational Summits in over 30 countries across the globe. The Academy is powered by three pillars: education, networking, and cultural immersion.
Michelle is a Senior Consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Sue is a senior consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Gayle is a Senior Consultant with TPG Data Services (TPG-DS). TPG-DS and our team of senior healthcare and clinical consultants are transforming the way providers and payors monitor healthcare information to control costs and enhance efficiencies.
Nancy is a Senior Vice President with The Pharmacy Group, responsible for all financial aspects of the TPG Family of Companies, as well as operational matters. She joined The Pharmacy Group in March 2012, in addition to performing the overall financial management she evaluates project profitability and pricing, manages cash flow, analyzes financial performance, and makes financial recommendations. Additionally, she handles HR functions, and frequently is involved in client contracting.
Jeff joined The Pharmacy Group (TPG) in August 2008 to support its administrative functions. Over the years he has taken on additional responsibilities including marketing initiatives, client communications, and general web support. As a vice president Jeff is primarily responsible for attendee recruitment for all TPG activities, from the planning and strategy of recruitment to the execution and oversight of those initiatives.
Mr. Brook has over 30 years in health care industry management and consulting. He has managed medical and health economic educational programs, convention activities, and promotional product support as both an employee and a consultant. He has worked on market access programs with the National Payor Roundtable since the organization formed in 2005, (as the National Managed Care Roundtable). He managed the daily operation of a pharmacy benefit manager’s formulary programs and was instrumental in the development and implementation of over 20 custom formularies. Mr. Brook has worked with state and federal agencies in refining the diagnosis-related-group system, in developing the resource-utilization-group system—part of the U.S. Federal Long-Term-Care Minimum Data Set, and in developing a mental health classification and reimbursement system. Mr. Brook has taken an active role in the developing and reporting the results of the National Payor Roundtable advisor survey. He reviews for several journals including the American Journal of Managed Care and Current Medical Research and Opinion. He has a variety of therapeutic experience with marketed and developmental products and holds several degrees from Rensselaer Polytechnic Institute, including an M.S. in operations research and statistics, an M.B.A. in health systems finance, and a B.S. in management information systems.
Dr. Sax is co-founder and President of The Pharmacy Group LLC in Glastonbury, Connecticut where he provides marketing services to healthcare service providers; pharmaceutical, biotech, and medical device clients; and information technology and companies to grow revenue and improve the financial performance of their products and services.
Rich Balest has served as a health industry consultant utilizing over 25 years of experience in data mining, data modeling, data warehousing, and information delivery. Rich has comprehensive experience analyzing detailed claims and eligibility from CMS, insurance companies, and managed care organizations including prescription benefit managers (PBM), and account and medical record detailed patient data from hospital patient accounting systems, clinical ancillary systems, and professional and institutional billing systems.
Sarah is a Vice President of Business Development for The Pharmacy Group (TPG). Her primary responsibility is coordinating business growth across the various LLCs in the TPG Family of Companies. She joined The Pharmacy Group in February 2015— initially to augment the organization’s business development and administrative activities. In the years since she has worked on marketing initiatives, client communications, general web support, and program development.
Marjorie Pestel Zimmerman, MS, BS Pharm, is a registered pharmacist with diverse experience in the healthcare industry. During her practice in a large tertiary care center, she held numerous positions, including decentralized clinical pharmacist and Assistant Director of Operations within the pharmacy department. As a consultant for a psychiatric hospital, she performed medical staff drug usage evaluations and led patient medication groups.
In August 2015, Leon Edelsack became the President of TPG Healthcare Consulting (TPG-HC) and also serves as the president of TPG-HC’s sister company, TPG Data Services (TPG-DS), a position he has held since 2009.