Wednesday, May 2, 2018

ESI Reachs Deal on Struggling Cholesterol Drug with a List Price Over $8000

Image result for praluent copay cardDrugmakers Regeneron and Sanofi are cutting the price they charge pharmacy benefit manager Express Scripts for their cholesterol medicine, Praluent. In return, Express Scripts will remove almost all restrictions on the medicine, and make it cheaper for patients. In theory, that should mean a sales boost.

“I really hope this works because otherwise it's a bad message for everyone going forward,” says Steve Miller, Express Scripts’ chief medical officer. Why? Miller says that Praluent was hurt by a high price (list: $14,000 a year), and a lack of proof that it helped patients. But now, Miller says, things have changed.

Tyrone's Commentary:

1) Reads as if ESI is rubberstamping the PA (prior auth) for a drug with a list price of more than $8,000.
2) Plan sponsors need to understand the manufacturer-side revenue ESI is generating for itself and its affect on your final plan cost!
3) The drug appears to be cost-effective even at the high price tag, but make sure not to be wasteful in your spending
4) Plan sponsors may want to consider implementing their own step therapy and PA processes or excluding the drug all together except for extreme cases   

New data presented in March seems to indicate that Praluent not only prevents heart attacks, but may save lives. And Regeneron and Sanofi opened themselves up to an independent analysis, by the Institute For Clinical and Economic Review, that showed the medicine was cost-effective at a price below $8,000 for high risk patients. Now they’ve cut the price.

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