PBM Drug Exclusion List Changes for 2024

IPD's report, “PBM Drug Exclusion List Changes for 2024,” covers changes in the 2024 drug exclusion lists from the three largest pharmacy benefit managers (PBMs): Express Scripts, Optum Rx, and CVS Caremark.

Noteworthy 2024 exclusions include widespread changes to preferred Humira biosimilars and insulin products and an increasing frequency of drug exclusions in rare disease and oncology.

The number of high-cost drugs approved over the past several years has prompted payers to implement stricter management tools and formulary exclusions to curtail rising drug costs. Our report examines potential motivations and trends underlying the changes to PBMs’ drug exclusions lists in 2024.