Express Scripts has said it will include Amgen and Sanofi’s new cholesterol-lowering antibodies on its formulary, but is taking steps to make sure spending on the drugs is restricted.
Amgen’s Repatha (evolocumab) and Sanofi’s Praluent (alirocumab) – the first medicines in the new PCSK9 inhibitor class to reach the market – have both been shown to be effective at reducing low-density lipoprotein (LDL) cholesterol in patients who struggle to meet treatment targets with current drugs such as statins.
They have been launched at a cost of around $14,000 a year however – much more than generic statins – and there have been concerns that widespread use could inflate medicines spending and put healthcare services under strain.
US pharmacy benefit manager (PBM) Express Scripts says that “a combination of discounts and a rigorous utilisation management programme’ will keep spending on the drugs through its national formulary down to around $750m in 2016, which it maintains is “far lower than industry forecasts.”
There had been speculation that the PBM might opt for one PCSK9 inhibitor over the other – a tack it adopted with the launch of new and expensive hepatitis C virus drugs last year – giving an exclusive formulary listing in return for a steep discount.
“We are confident that we have received the best price possible for both products, without needing to exclude either,” it said in a statement.
Amgen welcomed the inclusion of both new drugs, saying it is important to preserve physician and patient treatment choice for patients who need intensive and predictable LDL lowering.
“This is an important milestone for patients,” said Anthony Hooper, the company’s executive vice president of global commercial operations. “We will continue to engage constructively with other payers to enable patients to have access to Repatha.”
Among the measures implemented by the PBM is 24-hour access to specialist pharmacists and nurses who will make sure patients know how to use the drugs properly in order to comply with the therapy and achieve the best possible outcome. Both drugs are biologics that require self-injection once every two or four weeks.
While the scale of the discounts have not been disclosed, getting the two PCSK9 inhibitors onto a national formulary is a key achievement for Amgen and Sanofi, particularly in light of the recent Institute for Clinical and Economic Review (ICER) report which concluded they were “vastly overpriced.”
ICER suggested the price of the drugs would have to be cut 85% to a little over $2,000 make them cost-effective.