Thread by @BethWaldron

1) Good evening.
Tonight's #CVS Caremark #PBM topic:
Prior authorization & filing exemptions for patients. Caremark is touting this to clinicians as a way patients currently on #Eliquis can remain on it after Jan 1. It's complete BS.😲 Here's why---->
THREAD

2) CVS Caremark's 'Executive Escalation Team' has been working with me to explore ways I & other patients can remain on Eliquis. I will use myself as example. I've been stable on Eliquis for 8 years. Here's what my exemption process will look like:

3) trial and failure of warfarin will not be required as a condition for approval (whew...did warfarin for 10 years & I NEVER want to go back!)

4) Patients will be required to have tried/failed or had an intolerance to Xarelto and meet other clinical indications in order to be approved.

5) what is "other clinical indications"? Good question. I don't have that answer. What I do know is....

6) If Eliquis is approved for coverage thru the exceptions process, it would be covered at the Tier 3 copay level, meaning it would be subject to deductible and coinsurance. For comparison: Xarelto is Tier 2, warfarin Tier 1.

7) Currently, Eliquis is Tier 2. So a patient currently stable on Eliquis at Tier 2 would need to have a serious adverse event on Xarelto before they could then be approved by CVS to go back on Eliquis but at a higher Tier 3 (checks notes🤓 yep, strange, but that's correct)

8) What does that mean in practical terms? For me personally, IF I were approved for an exemption the cost difference would be an additional $2400 annually to remain on the medication I've been taking for 8 years, with the same insurance the entire time.

9) Consider what this prior auth process is going to do to our health providers. They are going to get slammed with exemption requests or new scripts! I know 1 doctor with 1,110 impacted patients. Each requires a medical review, patient counseling.

10) Has anyone considered the possible medication errors? Your having patients who for YEARS have been taking 2x dosing being switched suddenly to 1x dosing...some will surely slip up and take Xarelto 2x day out of habit. We're adding unnecessary risk variables.

11) Patients are largely unaware they can ask their doctor to file an exemption to remain on Eliquis. But there has to be a valid medical reason or it WILL be denied. They are also unaware of financial assistance programs. CVS has not informed them of either. Poor communication.

12) Tip to clinicians:
Caremark suggests citing safety concerns with switching to other anticoagulants in your exemption requests. Seriously. Honest & truly cross my heart they did.✋

13) In conclusion: While the prior auth/exemption process is touted by CVS Caremark as a way for patients to retain access to Eliquis, it's a bunch of hokum. Reality is few patients will qualify & be helped, yet the administrative burden for clinicians will be high.