- Express Scripts plans to roll out a program aimed at improving patient access to preventive treatments for migraine, adding Amgen and Novartis' Aimovig and Eli Lilly's Emgality to its list of preferred medicines.
- The payer's move is bad news for Teva Pharmaceutical, which also has a marketed CGRP inhibitor that it expects to be a driver of near-term growth. The emerging CGRP class blocks a protein believed to play a role in headache development.
- In a Wednesday statement, Express Scripts said its Migraine Care Value program will start April 1 and operate by having specialist pharmacists from the company's Neuroscience Therapeutic Resource Center "identify patients using high amounts of acute migraine treatments, and work with them and their physician to move them to an appropriate preventive treatment."
Aimovig (erenumab) enjoyed a few short months on the market before Lilly's and Teva's rival therapies gained approval. The head start has helped secure market share, with total Aimovig prescriptions cresting over the 25,000 mark for the week of Oct. 5, a week-over-week increase of nearly 20%.
What it hasn't done, however, is bring in substantial revenue for Amgen or Novartis, which are initially offering the medicine for free through a drug trial program. Lilly's in a similar boat as it tries to play catch up; it's offering as much as a year of free Emgality (galcanezumab) to commercially insured patients that meet certain eligibility requirements.
Analysts note that such tactics, while helpful for driving initial volume, only work for a short time when the market in question is increasingly competitive.
"They're all viewed as pretty big products, at least in the billion [dollar] range if not more, depending who you ask," Credit Suisse analyst Vamil Divan said of marketed CGRP inhibitors in an interview with BioPharma Dive earlier this month.
"So far we've seen tremendous volume and lot of patient and physician interest in the space, but it's pretty much been free drug," Divan said. "Over the next six months, people will want to see the volume uptake turn into actual sales. So by the first quarter, second quarter calls next year, if it's very minimal sales then people are going to start getting disappointed."
Aimovig, Emgality and Ajovy all carry the same wholesale acquisition cost of $6,900, yet Express Scripts chose not to include the latter on its list of preferred medicines. The pharmacy benefit manager didn't respond to a BioPharma Dive request for more details on this decision, but it does deal another blow to Teva, which has faced headwinds in other parts of its business as of late.
"The similarity between products, in terms of both efficacy and safety, and the closeness to launch, had set up an interesting battle for supremacy between Amgen, Eli Lilly, and Teva," wrote GlobalData analyst Rahael Maladwala in an Oct. 17 report. "However, the lack of coverage by Express Scripts — which provides insurance coverage to 25 million Americans — has handicapped Teva considerably, leaving Amgen and Eli Lilly fighting for the top spot."
A spokesperson for Aetna, one of the largest insurers in the U.S., said in an email the company is currently reviewing the entire CGRP inhibitor class, including Aimovig and Emgality. Representatives from Anthem, CVS and OptumRx did not return requests for comment by the time of publication.
Per Express' Scripts new migraine program, neuroscience specialist pharmacists will guide patients taking preventive migraine regimens on adherence and, for those receiving injectable CGRP drugs, how to administer them for best results. The company is also offering plan sponsors reimbursement for patients who discontinue CGRP inhibitor therapy in the first 90 days of treatment.
"While drug makers have priced CRGP inhibitors in line with independent value-based assessments from organizations such as the Institute for Clinical and Economic Review (ICER), they are significantly more costly than previously available preventive migraine therapies and thus require conscientious management to ensure optimal patient outcomes," Express Scripts said in its Oct. 17 statement.