Express Scripts Holding Co., the largest prescription drugs benefits provider in the U.S., announced on Tuesday, Oct. 6 that it will start to cover two new cholesterol drugs made by Amgen and Regeneron/Sanofi.
Express Scripts is allotting $750 million in funds to cover for Amgen's Repatha and Regeneron/Sanofi's Praluent in 2016, and they are not looking at spending much more than that, thanks to the deals they closed recently.
Starting Monday, Oct. 12, Express Scripts will be paying for the drugs of about 25 million people included in their coverage list. The program will be implemented on a national level; however, it will be subjected under several conditions.
For one, the patients should go through one of the specialty pharmacies of Express Scripts. They or their physicians will then need to submit medical records to prove they are qualified to take the medicines. The said protocol may mean showing high cholesterol levels and exhibiting inadequate control of their cholesterol levels despite the administration of standard anti-cholesterol drugs, such as statins.
Should the drugs' prices increase way beyond the set costs for each year, Express Scripts will necessitate Amgen and Regeneron/Sanofi to grant rebates.
Express Scripts had agreed to cover for any expenses on top of a specific amount per individual per year.
Repatha and Praluent belong to a new class of drugs called PCSK9 inhibitors, which fight off bad cholesterol by more than 60 percent. The medicines are also recommended for patients whose cholesterol levels cannot be controlled by statins anymore.
Insurance firms have been worried about the skyrocketing costs of the drugs, should it be prescribed widely as the estimated annual sales may reach up to $10 billion.
Over the recent months, Express Scripts had openly admitted that they are considering to cover only one of the two drugs, if that would be the way to achieve adequate discounts. However, with the final decision made by the company, it no longer seems to be the case.
"But this time, we have been able to put in place strong utilization management to make sure only patients that meet (U.S.) label criteria get on the drug and we get a discount on top of that," said Steve Miller, the chief medical officer of Express Scripts. He added that the company is confident that they have obtained the best price for both drugs, without having to reject either.
"As always, we make sure our patients access the right medications at the best possible price with the greatest level of care," Miller said in the company press release.
Express Scripts would rather not disclose how much discount they have obtained after their negotiations with the two pharmaceutical companies.
Photo: Paul Sableman | Flickr