Largest US benefits manager warns PCSK9 meds will 'wreak havoc' on payers
- Now that Praluent (alirocumab) from Regeneron/Sanofi is FDA-approved, payers like Express Scripts are balking at the annual $14,600 ($40 per day) price tag.
- Standard anticholesterol drugs, including the generic versions of popular statins like Lipitor (atorvastatin) from Pfizer and Zocor (simvastatin) from Merck, often cost less than $50 per month.
- Express Scripts is the largest Pharmacy Benefits Manager (PBM) in the U.S. and wields a substantial amount of pricing power based on its size and scale. And it's not mincing words about the blockbuster prices of these new blockbuster drugs. "While these drugs are being viewed as breakthroughs, they also have the potential to wreak financial havoc on clients," Express Scripts President Tim Wentworth told reporters and investors on an earnings call Wednesday.
Let's just call Express Scripts the activist PBM. Within the last two years, as biopharma has delivered breakthrough specialty drugs in the areas of cancer (PD-1 inhibitors), hepatitis C (oral drugs with short regimens and high cure rates), and now hypercholesterolemia, Express Scripts has issued "dire" warnings about other classes of drugs as well, including its warning that that if every eligible Medicaid patient or prisoner were to take Sovaldi (sofosbuvir), it would end up costing states a total of $55 billion. Many of these claims have drawn eye rolls from pharma companies who say that the PBM is massively over-estimating the costs of these drugs to the health system.
And then there's its determination to rein in the costs associated with the new PD-1 inhibitors used to treat cancer, and its movement towards a system of indication-based pricing in which payers would pay different prices for drugs based on therapeutic outcomes.
But if anything shows that Express Scripts means business, it's the move the PBM took in December 2014 when it essentially excluded Gilead's hep C drugs in favor of AbbVie's VieKira Pak (ombitasvir, paritaprevir, ritonavir) at a significant discount.
While it's not clear what strategy Express Scripts will use to rein in costs associated with the new PCSK9 inhibitors, what's clear is that there will be strenuous efforts to bring down the overall cost associated with these promising new drugs. And considering the fact that an FDA approval for Repatha (evolocumab) is not far down the pike, there is a strong possibility that Express Scripts could pit the two drugs against each other and try to strike the best deal.