December 9, 2021
The National Blood Clot Alliance (NBCA) has learned the largest pharmacy benefits manager (PBM) in the United States, CVS Caremark (part of CVS Health), has made changes to their 2022 commercial formulary which will reduce anticoagulant (blood thinner) choice for patients. Among the most significant changes impacting the largest number of patients is the coverage exclusion of Eliquis® (apixaban) from the CVS Caremark Preferred Drug List.
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.
The covered preferred alternatives indicated by CVS Caremark are Xarelto®, also a Factor Xa inhibitor or warfarin. Patients stable on Eliquis® will need to transition to one of these drugs beginning January 1, 2022 or be willing to pay 100% of the cost of Eliquis®.
Both Eliquis and Xarelto are next-generation blood thinners, known clinically as Direct Oral Anticoagulants (DOACs). These are alternatives to warfarin, but unlike warfarin, they do not require any continuous blood monitoring while being used.
“As a patient, I depend upon being optimally anticoagulated to prevent another life-threatening blood clot”, said Leslie Lake NBCA President. “So, I understand how alarming this is for patients stable on their blood thinning therapy to suddenly be forced to switch medications for non-medical reasons.”
“Treatment choices for patients with DVT/PE should be based upon clinical evidence, while also taking into consideration patient preferences and their risk tolerance,” said Alok A. Khorana, MD, FACP, FASCO who is a Professor of Medicine at The Cleveland Clinic and serves as the Chair of NBCA’s Medical and Scientific Advisory Board. “An anticoagulant change mid-treatment for reasons other than medical necessity creates not only an unnecessary burden for patients but is also potentially hazardous to their health by introducing a new source of variability for an otherwise stable patient.”
What is NBCA doing?
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 goes against NBCA’s stance on patient choice. The sudden, non-medical switching of stable patients off their anticoagulant therapy is dangerously disruptive for patients reliant on blood thinners to manage clot risk. NBCA is concerned about such practices and has joined forces with a coalition of 14 nonprofits to tackle this important issue.
We are asking CVS Caremark to allow patients to continue their current anticoagulation therapy. Additionally, we are actively advocating for federal policy changes to ensure blood clot patients continue to have the full range of treatment options available, not just now but for years to come. We will share more details of our advocacy in the coming weeks.
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?
Not all patients currently taking Eliquis® are impacted by this change. This change applies to commercially insured patients with CVS Caremark as their insurance plan’s pharmacy benefit manager (PBM). If you are impacted, you should have received written notification from CVS Caremark and/or your insurer. If you have questions or concerns about if you are impacted, please contact your health insurance plan.
For media inquiries:
Tarin Patrikis, Deputy Director
National Blood Clot Alliance