However, even with those discounts Repatha and Praluent are likely to be billion-dollar blockbuster drugs next year. Express Scripts intends to provide additional long-term protection for its payers and patients by capping the entire plan cost in 2016 for PCSK9 inhibitors for clients enrolled in the CCV program. For the large majority of the more than 70 million people with high cholesterol, statins are the clinically appropriate, tried-and-true therapy.
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“We really have swelling security, which is truly essential,” Express Scripts Chief Medical Officer Dr. Steve Miller said in a phone meeting Tuesday. That’s still a lot of money, but at least it’s far more manageable than it would have been otherwise.
A report from the Institute for Clinical and Economic Review said the price tag for these drugs should have been 15 percent of its list price to ensure health care budgets don’t suffer a strain.
Express Scripts’ plan to cover both Sanofi’s and Regeneron’s Praluent and Amgen’s Repatha will save money for the employers it works with, but spending on the medications could still approach new drug records, Forbes reported.
The agreements are part of Express Scripts’ National Preferred Formulary list of drugs, which covers 25 million Americans.
Anthony Hooper, executive vice president of global commercial operations at Amgen, commented on the development: “We are delighted that Express Scripts has chosen to preserve physician and patient treatment choice for patients who need intensive and predictable LDL lowering”. Praluent was approved in July with Repatha gaining approval a month later.
Initially, that would seem to indicate that prescription volume will come predominately from people with stubbornly high cholesterol levels caused by specific genetic mutations that don’t respond to statin therapy. In Europe, both drugs won broader approval for patients who are statin intolerant, which will dramatically widen the pool of patients who may try them.
Statin drugs, pills used to treat cholesterol, are far less expensive, mainly because so many are available as generics. More than 73 million US adults, or almost one-third, have high LDL cholesterol, according to the Centers for Disease Control and Prevention.
The price of prescription drugs is increasingly in the public eye. The drug was being tested on patients with human papillomavirus-associated cancers. Before the first of the two hit the market, the PBM rolled out a system to strictly limit use, using “rigorous clinical documentation to ensure access to the right patients” and minimize “wasteful spending”, the post states.
For more information about Express Scripts, visit Lab. Express-Scripts.com or follow @ExpressScripts on Twitter.
When the FDA approved competitor AbbVie’s hepatitis C treatment, Viekira Pak, at about the same cost, Express Scripts negotiated a substantial discount with AbbVie, and took Sovaldi off the formulary.
In the meantime, it will be a standard market-share contest between drugs with similar benefits and nearly identical FDA indications. Express Scripts and others loosened their eligibility requirements as the price dropped.
The news will be a big boost for both the drugs as Express Scripts chose to include both in the plan. “No. Did they get the level of discount they wanted? No”.
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He would not specify what level of discount it received: “Did we get the price we wanted?”
