CVS dermatologic formulary restrictions

Patients on the CVS Caremark Advanced Control Formulary will lose access to several topical medications and even be forced to switch from one biologic treatment to another under new rules that are currently in effect. As of Jan. 1, 2017, the pharmacy benefits manager (PBM) will no longer cover Enbrel, Cosentyx, and Otezla for psoriasis patients. Patients on these drugs will have to switch to Humira, Taltz, or Stelara in order to have their treatments covered.

Exceptions will only be available if dermatologists navigate a formulary exception process that requires them to deal directly with a physician employed by CVS. However, patients whose physicians appeal on their behalf will be able to remain on their current treatment and be covered during the appeal. The AADA has developed a downloadable template appeals letter for Cosentyx, Enbrel, and Otezla. For more information, contact David Brewster at dbrewster@aad.org.

In addition, the PBM removed some topicals from its formulary that were never FDA approved, but instead, had been grandfathered as being safe, including Dermazene, Proctocort, hydrocortisone-pramoxine, and hydrocortisone-iodoquinol.

Download appeal letters

Click on the drug names below to access templated appeal letters.

Enbrel Cosentyx Otezla