- The difference in dosing between Amgen's Repatha (evolocumab) and Praluent (alirocumab) from Sanofi/Regeneron may give Praluent a distinct advantage over its rival PCSK9 cholesterol drug.
- Assuming both drugs are approved, Repatha will be available as either a 140 mg biweekly injection, or a monthly injection of 420 mg. Praluent will be available either in biweekly injections of 75 mg or 150 mg.
- Sanford Bernstein analyst, Geoffrey Porges, anticipates that the cost differential between 75 mg Praluent and 150 mg Praluent will allow Sanofi to price the drugs at two price points—$5,000 and $10,000.
The context for this discussion is a situation in which payers are concerned about high-priced specialty drugs. Given the intense LDL-lowering effects of PCSK9 inhibitors (roughly 60% in clinical trials) and the targeted population they are intended for (those with hard-to-treat, refractory, or familial hypertension), pricing will ultimately be a major concern as payers try to determine who should be eligible and how hard to fight to push prices down. With an estimated treatment population of 15 million people and an estimated price of $10,000 per year, payers are looking at big potential scuffle with pharma.
On the other hand, Amgen and Sanofi/Regeneron can make the case that treatment with PCSK9 inhibitors reduce the risk of cardiovascular events, including heart attack and stroke. In the final analysis, it will come down to weighing costs versus benefits—and then creating a pricing policy around those issues. It promises to be a contentious debate, but the advent of this new class of drugs is exciting nonetheless.