For eight years, Beth Joyner Waldron has counted on Eliquis to treat clots in her lungs and legs.
In November 2021, she received a letter from CVS Caremark telling her the pharmacy benefit manager is excluding Eliquis from its formulary next year. Receiving the letter made her emotional.
Just a year ago, her father bled to death. Joyner Waldron said he had an adverse reaction to his blood thinner.
"I nearly died from my blood clots 18 years ago and I know from my dad's experience the treatment carries a high risk," Joyner Waldron said. "I've been stable, I've not had any bleeds, and then I get this letter saying I have to switch meds, that obviously induces anxiety."
She also was angry that the letter did not include information on how to appeal the decision.
As of January 1, one of the nation's largest pharmacy benefit managers no longer covers a blood thinner that Joyner Waldron and an estimated 3 million others rely on to prevent and treat blood clots. Just five weeks before the formulary change was made, CVS' $39 billion Caremark subsidiary sent letters to its commercial enrollees, alerting them that they would need to switch from Bristol-Myers Squibb's Eliquis to Janssen Pharmaceuticals' Xarelto, both anticoagulants that experts say have never been proved to be interchangeable through randomized control trials.
The formulary exclusion comes as PBMs increasingly drop medications from their coverage lists, attracting attention from federal and state lawmakers aiming to reign in non-medical switching, said Ryan Gough, executive director of the Partnership to Advance Cardiovascular Health, a patient advocacy group.
"I've never seen an issue galvanize the cardiovascular community like this," Gough said.
The decision sparked outcry from 14 patient advocacy groups, which wrote to CVS Health's chief medical officer in December calling for him to reverse the "dangerously disruptive" decision. Experts from the American College of Cardiology and American Society of Hematology also continue to meet with CVS Caremark about the move.