More bad news for Glaxo. Prime Therapeutics, which covers about 12.5 million people, made the move “after careful examination of clinical literature regarding the safety and efficacy” of the drug, according to a statement. The PBM has been looking at the drug since May following the controversial meta-analysis in the New England Journal of Medicine raised concerns about a big increase in cardiovascular risk.

Prime cited its own “in-depth analysis” of medical and pharmacy claims, which found that more than 25 percent of patients on Avandia had a history of coronary artery disease or heart failure, and also noted that since the meta-analysis, the PBM has seen a 58 percent decline in Avandia use. Although an FDA panel recently recommended Avandia remain on the market, Craig Mattson, Prime’s senior director of drug technology assessment and formulary development, apparently wasn’t convinced the benefits outweigh the risks. “Prime takes drug safety warnings very seriously and our primary concern is the safety of our members,” he says in the statement.

HealthTrans officials feel the same way. And so the PBM will remove Avandia from the beginning of next year. The pharmacy and therapeutics committee has “to make some tough decisions about discontinuing drugs that they have determined present significant risks,” ceo Jack McClurg, says in a statement, adding that Takeda’s Actos should be moved to the third tier of the formulary.

“Our P&T committee analyzed available data and weighed the benefits with the potential risks and determined that Avandia presents a greater risk for adverse events than benefits at this time,” says HealthTrans director of clinical services Ryan Haynes.

So who’s next?