People taking medication for diabetes or certain types of cancers may notice some changes when filling prescriptions at CVS pharmacies.

Earlier this week, CVS released its list of medications to its investors alerting them to what they will or will not carry.

This list, known as their “formulary management strategy,” looks at more cost-effective treatments for its clients and customers.

Of particular note is their expanded inclusion of biosimilars and follow-on biologic drugs to replace drugs with significantly higher costs.

In its announcement, CVS said the move will be “a key component” of their 2017 strategy.

Specifically, the nation’s largest pharmacy chain has announced two drugs it will be replacing with biosimilars. The drugs are nearly identical to those already approved by the U.S. Food and Drug Administration (FDA).

The Biologics Price Competition and Innovation Act (BPCI Act), part of the Affordable Care Act (ACA), makes it easier for biosimilar drugs to enter the market if data show they’re safe and “highly similar” to an already approved product.

The drugs on the market are referred to as the reference product.

“That means patients and healthcare professionals will be able to rely upon the safety and effectiveness of the biosimilar or interchangeable product, just as they would the reference product,” according to the FDA.

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Switching to biosimilars

Unlike other pharmacy chains like its major competitor Walgreens, CVS is able to dictate what drugs it carries because it operates under its own pharmacy benefit manager (PBM).

These programs are collective bargaining entities that dictate which drugs hospitals, pharmacies, and programs like Medicare Part D carry.

CVS’ PBM is one of the largest in the country as it directly relates to what will be carried in their 9,600-store chain.

The drugs for 2017 include Sandoz’s Zarxio, a biosimilar that is similar to Neupogen, to decrease the risk of infection in patients receiving cancer treatments. The other is Basaglar, which CVS is using to replace the long-lasting insulin treatment Lantus for treating diabetes.

In March 2015, Zarxio became the first FDA-approved biosimilar drug. It was based on Amgen Inc.’s Neupogen (filgrastim), which was approved in 1991.

“Patients and the healthcare community can be confident that biosimilar products approved by the FDA meet the agency’s rigorous safety, efficacy, and quality standards,” then-FDA Commissioner Dr. Margaret A. Hamburg said in a press release.

Zarxio hit the market at a 15 percent discount to Neupogen.

Both are approved to prevent infections in people undergoing specific cancer treatments, including people undergoing various types of chemotherapy, bone marrow transplantation, and autologous peripheral blood progenitor cell collection and therapy. It’s also approved for people with severe chronic neutropenia, a rare blood disorder.

Basaglar, manufactured by Eli Lilly and Company, received FDA approval in December 2015. It’s considered a “follow-on product” because there’s no insulin glargine product licensed under the Public Health Service Act.

Lantus is a once-a-day injectable insulin medication for people with type 1 or type 2 diabetes. Because of its high cost — around $400 per 100 milliliter pen — many insurance programs, including Medicare, didn’t cover the drug.

A price for Basaglar has yet to be released.

The CVS list also shows 33 other high-ticket drugs it will not be carrying, including heavily branded name drugs. They include those that treat asthma, pain, cystic fibrosis, hepatitis C, and others.

“We anticipate significant savings for many clients and members, as the removal of higher cost products will enable near-term value with additional future opportunities for savings resulting from market competition as more new products are launched,” CVS said in a statement.

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