CVS Health Corp. said Monday that Amgen's Repatha will be the only drug of a new class of cholesterol-lowering injections in its formulary. The U.S. Food and Drug Administration recently approved Repatha and rival drug Praluent, developed by Regeneron Pharmaceuticals and Sanofi.
Known as PCSK9 inhibitors, such drugs are intended for patients with high levels of low-density lipoprotein cholesterol who don't respond to statins. They have been found to reduce LDL levels by 60%.
But the launch of both drugs has fueled the debate over the rising costs of new drugs, with each treatment setting an initial price of more than $14,000 a year. Pharmacy benefits managers have been among the loudest critics, and they've responded by opting not to carry some newer brand-name medications in cases when negotiations failed to result in large enough discounts and an alternative drug was available.
Such was the case last December when the nation's largest PBM, Express Scripts, decided it would no longer cover Gilead Sciences' hepatitis C treatment Sovaldi in favor of a cheaper alternative produced by drug firm AbbVie. In October, the company surprised many by announcing it had approved both Praluent and Repatha for its formulary.
Last month, health insurer Harvard Pilgrim Health Care announced it would only carry Repatha as part of a deal that holds Amgen financially accountable if the drug does not significantly lower the cholesterol levels of plan members.
In a released statement, CVS said the decision to only cover Repatha came down to costs. It would not, however, share any of the financial details.
The company stated it had conducted an independent review of both Repatha and Praluent where both drugs were found to be “therapeutically equivalent.”
“CVS Health is committed to providing high-quality medications for our clients and their members at the lowest possible cost,” Dr. Troyen Brennan, CVS Health executive vice president and chief medical officer, said in a statement. “We have determined that choosing a single PCSK9 inhibitor for our commercial formularies allows us to get the best price possible for clients and preserves our commitment to deliver the best care available.”
Many have questioned whether PCSK9 inhibitors deliver enough value through savings from avoided health expenditures to warrant its list price. Many feel such prices for drugs do not make them cost-effective when compared with current therapies. Especially, when, in theory the treatments would need to be taken continuously for years.
A report released in September by the Institute for Clinical and Economic Review found both drugs would need to lower their listing price by more than 80% in order to be cost-effective.
A February article in Health Affairs estimated the long-term use of PCSK9 inhibitors could set the cost for treatment as high as $100 billion annually just among those patients where statins are ineffective.
