Express Scripts Holding Co. has struck a deal with the manufacturers of Praluent (alirocumab), one of two pricey PCSK9 inhibitors on the market, that will give the PBM a lower net price on the drug in exchange for streamlined patient access and an exclusive spot on the Express Scripts national formulary.
The pact comes after Regeneron and Sanofi announced in March that they would lower the net price of Praluent for payers willing to reduce access barriers for appropriate patients.
With the new deal on Praluent, the PCSK9 will be the preferred one on Express Scripts’ formulary. The prior authorization criteria will remain, but the PBM is easing the documentation requirements needed for approval, according to Express Scripts spokesperson Jennifer Luddy.
Beginning in July, Express Scripts will also share a portion of the Praluent rebates it receives with patients enrolled in the PBM’s Cholesterol Care Value program and who fill the medication at the Accredo specialty pharmacy.
PCSK9 makers have reported very high denial rates for their products among commercial payers, so they have been motivated to explore innovative ways of increasing utilization.
“Both Praluent and Repatha were typically covered by PBM formularies, but most plan sponsors had adopted fairly rigorous prior authorizations to control the usage of these products,” says Joshua Golden, area senior vice president at Solid Benefit Guidance. “Utilization was usually limited to patients who were unsuccessful at managing their cholesterol with the strongest available oral therapies, or patients with a heightened risk of heart disease. These front-end constraints have helped to keep utilization levels very low for these expensive products.”
Ashraf Shehata, a principal in KPMG LLP’s health care life sciences advisory practice, is optimistic that competition between Praluent and Repatha could lower net prices for both drugs.