Amgen announced Monday that CVS Health will provide preferred access to Repatha (evolocumab) through its Caremark commercial formularies. Meanwhile, the pharmacy benefits manager has decided not to cover Sanofi and Regeneron Pharmaceutical's PCSK9 inhibitor Praluent (alirocumab). Troyen Brennan, CVS's chief medical officer, remarked that the discount CVS obtained from Amgen for Repatha was "substantial," but he declined to reveal the amount or the length of the contract with the drugmaker.
"The key factor was the decision that the medications are therapeutically equivalent," explained Brennan, adding "once we made that decision, then we were like anybody else that's in a bargaining situation where you have two competitors interested in maximising revenues." Brennan noted that CVS's decision will take effect December 1, although he cautioned that the company will continue to limit the use of the therapy. CVS pointed out that statins would remain the standard of care for most patients, while PCSK9 inhibitors are necessary for "a small percentage of patients" unable to achieve their treatment goals with other therapies.
Anthony Hooper, Amgen's executive vice president of global commercial operations, commented that "value-based partnerships are a key area of focus for Amgen, and Repatha gave us a great opportunity to offer value-based contracts that address payers' concerns by linking the net price of Repatha to expected LDL cholesterol reductions and anticipated appropriate patient utilisation." Hooper continued "this is an important milestone for patients, and we will continue to engage constructively with other payers to enable patients to have access to Repatha."
Last month, Express Scripts announced that it would include both Repatha and Praluent on its 2016 national preferred formulary (for related analysis, seeViewPoints: Express Scripts agrees to share anti-PCSK9 risk with clients – but how much?). Meanwhile, Sanofi and Regeneron jointly stated they were "disappointed" with the CVS decision, saying "patients and physicians should have a choice regarding their treatment and access to the right therapy to meet individual patient needs." Sanofi and Regeneron also indicated that they remain in discussions with other insurers concerning coverage for Praluent.
Commenting on the news, RBC Capital Markets analyst Adnan Butt remarked "though an exclusive contract with CVS is not unexpected, it does raise the bar for [Sanofi and Regeneron] to deliver the same or at least keep the door to patient/physician choice open with other [pharmacy benefit managers], such as was done with Express Scripts."
Repatha was approved by the FDA in August and launched at an annual cost of $14 100, while Praluent had been cleared a month earlier at $14 600 a year.
In September, an analysis published by the Institute for Clinical and Economic Review concluded that the costs of both Repatha and Praluent were too high, and that they should be discounted by 67 percent to better reflect their overall benefits. For related analysis, see Spotlight On: Will payers be able to extract HCV-like discounts on anti-PCSK9 mAbs? See also Spotlight On: Anti-PCSK9 mAbs are pricey, but are they worth it? One analysis says yes – eventually.
