Express Scripts to cover both Sanofi/Regeneron's & Amgen's PCSK9 meds
- Express Scripts, the largest pharmacy benefits manager (PBM) in the country, has struck arrangements with pharma giants Sanofi/Regeneron and Amgen to cover the companies' PCSK9 inhibitor cholesterol-lowering drugs Praluent and Repatha. Unlike Scripts' stunning decision last year to favor AbbVie's Viekira Pak over Gilead's Sovaldi/Harvoni, the PBM won't be pitting the drugs against each other.
- Express Scripts says that its deal with the companies will strictly limit the patient population that can use the PCSK9 drugs, limiting the pool to patients who have failed prior statin therapy, have high cholesterol, and other restrictions. Similar restrictions have been outlined by insurance giants like United Health and Aetna.
- However, Forbes' Matt Herper notes that Express Scripts' estimates for Repatha's and Praluent's sales seem to be rather high, raising the question: Is the PBM inflating those estimates in order to impress its clients when drug spending is lower than expected?
It's still too early to tell how Repatha and Praluent will fare in their first year on the market. But Express Scripts' assumption, according to Herper, seems to be that the figure will reach between $5 billion and $10 billion per year (and that the PBM's clients would spend about $750 million on the medications).
That's a whole lot higher than many analyst expectations, particularly given payers' (including Scripts') efforts to limit PCSK9 patient pools. Express Scripts admitted to Forbes that if sales are more along the lines of analyst estimates of about $1.2 billion, the cost to clients would be more like $90 million.
Of course, $90 million and $750 million are two entirely different ball games. It's unclear why Scripts is assuming such high sales at the outset, although the theory Herper proposes ("inflate figures now to be pleasantly surprised later") does make logical sense.
Regardless, patients covered under Express Scripts-managed plans will have access to both major PCSK9 medications, which will also allow them to have a broader choice of dosing options for the drugs.