although so far the PBM hasonly dropped five drugs, targets could appear on the backs of otherhighly expensive drugs as reviews of products continues. (Photo:Getty)

Drugmakers, beware: if you boost the price on your products toomuch, a pharmacy benefit manager may just kick it off its list ofapproved formularies as the default option for doctors toprescribe.

That's what CVS Caremark has started to do, according toFierce Healthcare, to save its PBM clientsbucks. In fact, CVS Caremark estimates that it has saved its PBM clients anaverage of $15 per 30-day supply on drugs, with clients on its newformulary model paying an average of $88.30 for a 30-day drugsupply, compared to $102.58 for other formulary designs.

Related: 10 drugs topping employers' pharmaspend

In 2017, the program began to weed out "hyperinflated" drugsthat have much cheaper equivalents and don't have the qualitymetrics to back up those high prices. And although so far the PBMhas only dropped five drugs—leading to a 99 percent drop in use bymembers—targets could appear on the backs of other highly expensivedrugs as reviews of products continues.

One drug thus targeted is the muscle relaxant chlorzoxazone in250-mg tablets. Its cost averages $2,902 for a 30-day supply. Thelower-cost option is cyclobenzaphrene, which weighs in at aconsiderably lower average of $1.76 for a 30-day supply. Theremoval of chlorzoxazone, CVS estimates, could save clients $34,812on a patient's yearly supply.

"We continually review and identify drugs that are seeing highprice increases and those that are outliers based on priceincluding new market entrants," wrote Derica Rice, CVS Healthexecutive vice president and president of Caremark. "This flexibleapproach of ongoing reviews and removals—rather than annual—helpsensure that clients can stay ahead of rapidly changing markettrends, rather than simply reacting to market changes."

The other four drugs Caremark has already dropped include thediabetes extended release 1000-mg Metformin ER tablet, whichaverages $617 for a 30-day supply. Regular Metformin only costs$3.80 for a 30-day supply.

Then there's the nonsteroidal anti-inflammatory drug Femoprofenin 200-mg caplets, which averages $3,001 for a 30-day supply. Itsalternative, diclofenac sodium, only runs $6.62 for a month'ssupply.

The topical anesthetic cream lidocaine tetracaine costs $731 per30-day supply, but its cheaper alternative lidocaine prilocaine isonly $22 for a 30-day supply.

And last but certainly not least are the folic acid and vitaminD supplement Ortho DF 3,775 Unit-1 mg tablets, which cost $2,858for a 30-day supply. A regular folic acid supplement alone onlyruns $1.50 for a 30-day supply.

"Our focus continues to be on developing — and evolving —strategies that help our pharmacy benefit management clients stayahead of the changes," Rice wrote. "In 2018, we were ableto keep the impact of price growth to 3.1 percent despite drugprice inflation of more than 25 percent."

Read more: 

• Brand-name prescription drug prices double in 6 to8 years
• Majority of Americans support current efforts tobring down drug prices
• How small changes can lead to huge prescriptiondrug savings