In December of 2021, the National Blood Clot Alliance (NBCA) learned the largest pharmacy benefits manager (PBM) in the United States, CVS Caremark (part of CVS Health), made changes to their 2022 commercial formulary which reduced anticoagulant (blood thinner) choices for patients, including the coverage exclusion of Eliquis® (apixaban) from the CVS Caremark Preferred Drug List.
As of July 1, 2022, after objections and push back from patients and organizations, CVS Caremark has put Eliquis® back on its formularies.
Eliquis® is a Factor Xa inhibitor, an oral anticoagulant tablet taken twice a day and used for the prevention and/or treatment of blood clots (deep vein thrombosis and pulmonary embolism). It also reduces the risk of stroke in patients with atrial fibrillation.
CVS released a statement explaining that Eliquis was added back because it provided a lower net cost for patients from negotiations with the drug manufacturer. Read the full article. We applaud patients, advocates, providers, and organizations coming together to help make this change, but there is still work to be done! Many insurance pharmacy benefit manager (PBM) policies harm patients due to non-medical switching. It is time to put patients back at the center of healthcare, one small victory at a time. Sign up for our email list to stay informed about how you can take action and stay updated about our patient advocacy work.
What Role did NBCA Play?
The National Blood Clot Alliance (NBCA) believes that for equitable, individualized health care, patients and their physicians should have affordable access to all FDA approved anticoagulants. NBCA does not endorse specific medications. Rather, treatment decisions should be made exclusively between a patient and their clinician based on the clinical evidence that balances risks and expected outcomes with patient preferences.
The CVS Caremark decision to remove Eliquis® from its formularies went against NBCA’s stance on patient choice. The sudden, non-medical switching of stable patients off their anticoagulant therapy was dangerously disruptive for patients reliant on blood thinners to manage clot risk. NBCA joined forces with a coalition of 14 nonprofits to tackle this important issue and asked CVS Caremark to allow patients to continue their current anticoagulation therapy.
What is a formulary?
A formulary is a list of generic and brand name prescription drugs covered by your health plan. It is a ‘preferred drug list’. Your health plan may only help you pay for the drugs listed on its formulary.
What is a Pharmacy Benefits Manager (PBM)?
Pharmacy benefit managers (PBM) are companies that manage prescription drug benefits on behalf of health insurers. PBMs are primarily responsible for developing and maintaining a preferred drug formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims.
Who is The National Blood Clot Alliance (NBCA)?
The National Blood Clot Alliance (NBCA) is the largest patient advocacy organization focused on the prevention and treatment of life-threatening blood clots, such as deep vein thrombosis (DVT) and pulmonary embolism (PE)—together known as venous thromboembolism (VTE). NBCA is a 501(c)(3), non-profit, voluntary health organization and works on behalf of people who may be susceptible to blood clots, including, but not limited to, people with clotting disorders, cancer, traumatic injury, and risks related to surgery, lengthy immobility, childbirth, and birth control. NBCA accomplishes its mission through programs that build public awareness, educate patients and healthcare professionals, and promote supportive public and private sector policy. For more information, visit NBCA’s website www.StopTheClot.org.
What should patients do?
This change applies to commercially insured patients with CVS Caremark as their insurance plan’s pharmacy benefit manager (PBM). If you did not receive notice from CVS Caremark and/or your insurer, please contact your health insurance plan.
For media inquiries:
Tarin Patrikis, Deputy Director
National Blood Clot Alliance