Express Scripts plans to cover PCSK9 inhibitors on its national formulary
Express Scripts announced it would include the two recently FDA-approved proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors on its national preferred formulary, which covers approximately 25 million people in the U.S.
The largest pharmacy benefits manager in the U.S. will cover evolocumab (Repatha, Amgen) and alirocumab (Praluent, Regeneron Pharmaceuticals and Amgen), which are injectable medications that significantly lowered low-density lipoprotein (LDL) cholesterol in clinical trials in patients with clinical atherosclerotic cardiovascular disease and heterozygous familial hypercholesterolemia. The FDA also approved evolocumab for homozygous familial hypercholesterolemia.
Although the medications have been shown to decrease LDL cholesterol, they also come at a significant annual wholesale acquisition cost: $14,600 for alirocumab and $14,100 for evolocumab.
Express Scripts said most of the 70 million people with high cholesterol would continue to receive statins, which are much less expensive than the PCSK9 inhibitors.
In 2016, Express Scripts plans on spending approximately $750 million on PCSK9 inhibitors, which it said was lower than industry forecasts. Express Scripts said it would cap PCSK9 inhibitor costs for clients enrolled in its Cholesterol Care Value program.
Patients will have access to evolocumab and alirocumab through the Accredo Specialty Pharmacy and will be able to contact specialist pharmacists and nurses with any questions pertaining to medication adherence, proper injection methods and other issues that may arise.
“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,” Steve Miller, MD, senior vice president and chief medical officer at Express Scripts, said in a news release. “As a result, we are confident that we have received the best price possible for both products, without needing to exclude either.”
Since the approval of alirocumab on Aug. 27, Amgen has worked on helping patients afford the medication. The company said it offers one or more months of free alirocumab while insurance coverage is pending, has a $5 co-pay card for some patients and provides insurance coverage support and injection training.
Executive Editor
Tim Casey joined TriMed Media Group in 2015 as Executive Editor. For the previous four years, he worked as an editor and writer for HMP Communications, primarily focused on covering managed care issues and reporting from medical and health care conferences. He was also a staff reporter at the Sacramento Bee for more than four years covering professional, college and high school sports. He earned his undergraduate degree in psychology from the University of Notre Dame and his MBA degree from Georgetown University.