Cigna, a major US health insurer, has signed value-based pricing deals with the makers of two new PCSK9 cholesterol lowering drugs, Amgen and Sanofi. The companies will receive payment based on how well patients respond to the medications.
Last summer both Amgen’s Repatha and Renegeron’s Praluent were released on the US market with a list price of over $14,000 per year. The drugs were designed to help lower so-called “bad” LDL cholesterol in patients who were unable to tolerate more traditional statin-based therapies.
While many countries in Europe and around the world have implemented price controls on prescription drugs, the US has yet to put such a system in place. As a result, insurers and pharmacy benefits managers are forced to negotiate larger price discounts on increasingly expensive new treatments.
According to the new agreements, the drugmakers are required to further discount the cost of the treatment if patients fail to see a reduction in LDL levels equivalent to those seen in clinical trials. According to Signa, if the treatments exceed predicted cholesterol reduction power, the discounted price remains the same.
Regeneron’s head of commercial operations, Robert Terifay, says insurers will likely continue to use value analyses to negotiate pricing for therapies treating chronic conditions. Repatha and Praluent – both injectable drugs known as PCSK9 inhibitors – have had disappointing sales since their launch last year, due in part to insurers’ hesitance to cover the treatments.
Approximately 75 percent of Repatha prescriptions have been denied by payers, leading to frustration from both patients and physicians, according to Amgen. “We continue to work with payers to help them see the unintended consequences of an onerous system, resulting in patients with high LDL levels not getting access to Repatha,” said Amgen in a statement.
Chris Bradbury, senior vice president of Cigna Pharmacy said, Cigna utilizes a process “that ensures timely access to these very important breakthrough medications for the population that really needs these medications, while ensuring that there isn’t a lot of inappropriate or unnecessary utilization.” If results from ongoing larger clinical trials show the drugs prevent heart attacks and deaths, insurers may be more likely to cover the medications.