Express Scripts to Cover Both New Cholesterol Drugs

The first major showdown between two new effective but expensive cholesterol-lowering drugs resulted in a draw.

Express Scripts Holding Co., the big pharmacy-benefits manager, said it would include both drugs—Praluent from Regeneron Inc. and Sanofi SA and Repatha from Amgen Inc., on its national list of covered medicines.

That means that, among the 25 million people whose prescription plans are managed by Express Scripts, those who are candidates for the treatments will be able to choose between the two.

Insurance coverage for the two agents, known as PCSK9 inhibitors, has been an unanswered question since the drugs were approved this summer. The list price for Praluent is about $14,600 a year while Repatha is priced at $14,000.

Both drugs are approved for patients who can't achieve adequate cholesterol reduction on the widely used class of drugs called statins, most versions of which are generic and available to patients for a few dollars a month.

Using the combination of negotiated discounts and a special program that requires rigorous documentation that patients are candidates for the drugs, "we were able to achieve the economics we need" to include both drugs on the formulary, said Steve Miller, senior vice president and chief medical officer at Express Scripts. Dr. Miller declined to disclose terms of the discounts.

In a statement, Sanofi and Regeneron said they "are pleased that patients in the U.S. now have increased access to Praluent" and that they are "decided to establishing agreements with insurers to help achieve that goal."

Amgen termed the decision "an important milestone for patients" and said it "will continue to engage constructively with other payers to enable patients to have access to Repatha."

The drugs are injectable medicines that dramatically lower LDL or bad cholesterol that is a key culprit in heart attacks or strokes. Large scale studies are under way to determine whether the LDL reduction achieved with the drugs actually translate into fewer such events.

Write to Ron Winslow at [e-mail]

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(END) Dow Jones Newswires

October 06, 2015 18:15 ET (22:15 GMT)

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