The CVS 2018 drug formulary list is out, and diabetics may not see their preferred blood sugar drug listed anymore. This year, CVS/Caremark excluded two popular (yet controversial) medications from the formulary list — Invokamet and Invokana. This is likely due to the U.S. Food and Drug Administration’s May 2017 warning about these popular medications. The FDA’s communication confirmed ] these drugs can more than double toe, leg and foot amputation risks for diabetics. Data from two large clinical trials, CANVAS and CANVAS-R, showed both Invokana and Invokamet dramatically increased amputation risks for diabetics. It’s no surprise that CVS/Caremark decided to remove anything containing the drugs’ active ingredient, canagliflozin, from its 2018 formulary list.
Why Do Most Pharmacy Formulary Lists Change Every Year?
Formulary lists help large pharmacy chains curb unnecessary spending on costly prescription drugs not normally covered under most insurance plans. Each year, an independent expert panel carefully reviews the latest drug safety data, new clinical trial results and doctors’ recommendations. Then pharmacists, nurses, doctors and other experts on the pharmacy and therapeutics (P&T) committee review and approve formulary listing changes. These experts work independently of insurance companies as well as national pharmacy chains in updating each year’s recommended formulary lists.
However, the P&T panel have zero input on setting drug prices — insurers and pharmacy benefit managers manage that formulary aspect. These formularies help partially cover lower-cost drugs that are just as effective as their higher-priced competitors under most insurance plans. So if you’re currently taking Invokana, Invokamet or Invokamet XR to regulate blood sugar, ask your doctor about alternative treatments. In most cases, formularies show lower-cost alternatives with better safety profiles next to each drug excluded from this year’s list.
Invokana and Invokamet Alternatives Listed on Most 2018 Formularies
If you’re a type 2 diabetic currently taking Invokamet, ask your doctor about switching to Xigduo XR. Invokana patients can try substituting Jardiance (generic: empagliflozin), which appeared on every 2018 drug formulary list we could find online. CVS pharmacies carry multiple name-brand and generic drugs to help type 2 diabetes patients regulate blood sugar and related symptoms.
Injectable drug Victoza (generic: liraglutide) is known for reducing cardiovascular risks as well as its anti-obesity effects. Compared to Invokana, Victoza’s more likely to help with weight loss and doesn’t increase amputation or ketoacidosis risks. Invokana/Invokamet patients may see good results after switching to metformin.
What Studies Say About Invokana and Invokamet Amputation Risks
Doctors usually educate newly diagnosed diabetics about increased amputation risks from poorly controlled blood sugar. Until now, nobody thought a prescription drug specifically designed to lower blood sugar could more than double those amputation risks. According to the FDA’s adverse events database, toes were the most common amputation type reported among Invokana patients. However, the FDA’s most recent Invokana drug safety communication also listed amputations involving the “leg, below and above the knee.” Finally, the agency’s May 2017 warning also noted that “some patients had more than one amputation, some involving both limbs.”
The FDA now says doctors should consider all possible risk factors before prescribing Invokana or Invokamet. The agency listed several possible risk factors, including prior amputation history, peripheral vascular disease (PAD), neuropathy and diabetic foot ulcers. CVS/Caremark’s decision to exclude Invokana and Invokamet from their 2018 formulary list may help protect patients from increased amputation risks. While all drugs may cause side effects, only you and your doctor can decide whether the benefits outweigh possible risks.
What Invokamet Amputation Victims Can Do
If you or a loved one suffered amputations while taking medication containing canagliflozin, you may qualify for a cash settlement. Plaintiffs with ketoacidosis, stroke, kidney damage and other related injuries are suing the drug’s manufacturer, Janssen Pharmaceuticals, for negligence. To see within minutes if you may qualify for financial compensation, complete your free Invokana claim evaluation today. Once you’ve submitted your information, we’ll call with next steps to help you get the compensation and justice you deserve.
Related: Invokana Alternatives That Lower Blood Sugar in Type 2 Diabetics
Mandy Voisin
Mandy Voisin is a freelance writer, blogger, and author of Girls of the Ocean and Star of Deliverance. As an accomplished content marketing consultant, mom of four and doctor's wife, Mandy has written hundreds of articles about dangerous drugs and medical devices, medical issues that impact disabled Americans, veterans' healthcare and workers' compensation issues since 2016.