Express Scripts Holding Co said it has reached deals to cover two costly new cholesterol drugs and expects to spend no more than $750 million on them next year. It is the largest manager of prescription drug plans for U.S. employers and health plans.
"As always, we make sure our patients access the right medications at the best possible price with the greatest level of care," said Dr. Steve Miller, Senior Vice President and Chief Medical Officer of Express Scripts. "Since these new medications were approved a few months ago, our pharmacy experts have worked with medical professionals and our plan sponsors to ensure these drugs are used specifically by patients who will benefit the most. We are pleased to include both drugs on our National Preferred Formulary, and to put innovative medicines within reach of patients who truly need them."
Express Scripts, which has been a vocal critic of rising U.S. drug prices, would not comment on how much of a discount it had negotiated. It says total U.S. spending on the new drugs could reach $10 billion next year, far beyond Wall Street forecasts.
Praluent and Repatha are the first PCSK9 inhibitors to be approved by the Food and Drug Administration. Both products performed well in their initial clinical trials, and hold the promise to significantly lower LDL cholesterol levels for patients with clinical atherosclerotic cardiovascular disease and heterozygous familial hypercholesterolemia. Repatha has also been approved for the rarer homozygous familial hypercholesterolemia.
With a combination of discounts and a rigorous utilization management program for both Praluent and Repatha, Express Scripts' National Preferred Formulary clients collectively will spend approximately $750 million on PCSK9 inhibitors in 2016, far lower than industry forecasts. Express Scripts intends to provide additional long-term protection for its payers and patients by capping the entire plan cost in 2016 for PCSK9 inhibitors for clients enrolled in the CCV program.
"Aligned with our clients, we have achieved a more balanced marketplace, which has led to more collaborative discussions with manufacturers like Amgen, Regeneron and Sanofi, who share our interest in delivering innovative treatments to patients when clinically appropriate," said Dr. Miller. "As a result, we are confident that we have received the best price possible for both products, without needing to exclude either."
Express Scripts retains the ability to make future updates to the formulary status of the PCSK9 inhibitors based on new clinical data, additional drugs approved in this class, and the demonstrated preferences of physicians and patients.