Cholesterol drug still has price flab
los angeles — Amgen sells its cholesterol-lowering drug Repatha at a discount of about 30 per cent to its US list price of $14,000 a year, but the largest pharmacy benefit managers say they want lower prices after new data suggested more patients should be treated with the drug.
Amgen, which on presented data showing for the first time that Repatha cuts the risk of heart attack and stroke, said in a related presentation for investors that it is netting between $7,700 to $11,200 per annual treatment after discounts and rebates and believes those prices represent good value.
Sean Harper, head of research and development at Amgen, told
that current industry discounts average 30 per cent to 35 per cent.
“I think responsibly, if the number you are treating goes up and you are trying to recoup the cost of [developing] the drug... one would hope that the price would go down,” said Troyen Brennan, chief medical officer at CVS Health, the No.2 manager of drug benefit plans for US employers and insurers.
He expects the new data to widen eligibility for the treatment from roughly one million to at least four million Americans.
Steve Miller, CMO at Express Scripts, the nation’s largest pharmacy benefit manager, told he is “really focused on value-based pricing” and is “hopeful for additional improvements” in contract terms. Conversations about CVS’ contracts for Amgen’s drug and competitor Praluent, which is sold by Regeneron Pharmaceuticals and Sanofi , are under way, he said.
Amgen said it plans to offer additional contracting options, including refunding the cost of the drug for patients who suffer a heart attack or stroke, but emphasised that it believes current prices are fair.
“In fact, they may even be below the value-based range for the types of patients getting access now,” said Joshua Ofman, senior vicepresident of global value, access and policy at Amgen. “We want to engage payers in risk-sharing contracts. If the drug does not perform, net prices will go down. But if the drug performs as we expect, they will not.”
Repatha, approved by regulators in 2015, belongs to a class of injected antibody drugs that target PCSK9, a protein that maintains “bad” LDL cholesterol in the blood. It is aimed at the millions of people who don’t benefit from statins.
Statin pills, like Pfizer’s Lipitor, work very differently, blocking the liver’s production of LDL cholesterol, and cost only about $100 per year. Around one in four Americans age 45 and older is taking a statin.
Wall Street analysts have forecast that annual sales of Repatha and Praluent, which also has a list price near $14,000, could reach into the billions, but sales so far have been underwhelming as health providers and payers awaited evidence of improvement in cardiovascular risk. Sales of Repatha totalled $141 million last year.
The Medicines Co plans later this year to begin enrolling patients in a pivotal study of its experimental drug inclisiran, which is also designed to block PCSK9.
Chief executive Clive Meanwell said Medicines Co will seek a price based on the value of the drug and risk level of the patient, suggesting it would fall between $2,000 and $8,500 a year.
Amgen executives said the new Repatha trial results will clear the way for more patients to get access to the drug.
“Access restrictions have been a real challenge for patients and their providers,” said Ofman. He added that groups like the American Medical Association and the American College of Cardiology are beginning to play a larger role in working with payers to make sure drug utilization criteria are appropriate.
CVS’s Brennan said he would be waiting to hear from these groups about which patients should get the drug. —