CVS Health, a major retail pharmaceutical insurer and supplier has raised some consternation and concerns and it should also raise yours. Last Tuesday, CVS rolled out their 2017 formulary list that left off the some of the world’s top-selling drugs including a vital castrate resistant prostate cancer drug.

The pharmacy benefits manager removed from their list Medivation and Astellas’ prostate cancer treatment, Xtandi. They argued that Johnson & Johnson’s Zytiga is also a hormone therapy drug (and is cheaper than Xtandi) could be used in its place.

This is a problem as they are not the same drug. Their modes of action are totally different, one blocking testosterone and the other down regulating the production of testosterone. Additionally, Xtandi does not require the addition of steroids and Zytiga does.

This is step therapy gone astray that will mean that Xtandi will become out of reach for many of us, even if we have failed Zytiga.