CVS/Caremark Dropping Viagra From Drug Formulary

Image courtesy of (Felix E. Guerrero)

Patients who use the erectile dysfunction pill Viagra and whose health insurance drug coverage is through CVS/Caremark will have to pay cash or switch to Cialis: the pharmacy benefits administrator has removed the drug from its formulary, which is a fancy word for “list of drugs that we’ll pay for.”

Despite what all of the spam messages in your inbox tell you, generic Viagra isn’t on the market yet in the United States. That will happen in 2017, which is the same year that the patent on Cialis expires. The latter, which is made by Eli Lilly.

Here’s where things get confusing. By “CVS,” we don’t mean the CVS on the corner where you fill your prescriptions. That store will still sell Viagra, and you can use your insurance for it as long as you have a benefits administrator that isn’t CVS/Caremark.

The pharmacy chain shares a name and a parent company (CVS Health) with CVS/Caremark, a pharmacy benefits administrator once known as Caremark. They’re the companies that act as an intermediary between your pharmacy and your employer or your insurance company, determining how much the plan will pay for different drugs and which drugs the plan will or won’t cover. Their major competitor in this market is Express Scripts, and some insurance companies also handle their own drug benefits.

Even more confusing, the mail order pharmacy of CVS/Caremark handles the processing end of Pfizer’s direct-to-consumer Viagra mail-order program, which began in 2013 and requires a valid prescription. They’ll dispense Viagra by mail-order pharmacy, just not to their own customers.

No More Viagra: CVS Drops Coverage of Erectile Dysfunction Drug [Bloomberg News]