Cigna Corp. (Bloomfield CT) signed deals that will pay the makers of two potent but pricey cholesterol-lowering treatments based on how well their customers respond to the medications, the health insurer said.
The treatments, Repatha from Amgen Inc. (Thousand Oaks CA) and Praluent sold by Regeneron Pharmaceuticals Inc. (Tarrytown NY) in partnership with Sanofi SA (Paris), hit the market last summer with a list price of more than $14,000 per year.
They were approved for patients who are not able to take or adequately control “bad” LDL cholesterol with statins, such as Lipitor, the most commonly prescribed drugs for cholesterol. Statins typically cost only hundreds of dollars a year.
The deals are the highest profile examples to date of insurers basing payments on how well medicines perform for patients. Cigna and Aetna Inc. (Hartford CT) signed deals earlier this year for Entresto, a heart failure drug from Novartis AG (Basel CHE) that had slow sales because of its high price.
With no prices controls on prescription medicines in the U.S., as they have in Europe and elsewhere, insurers and pharmacy benefit managers (PBMs) have become far more aggressive in demanding price discounts.
Under the new agreements, if customers do not reduce LDL to levels reached in clinical trials, the drugmakers will further discount the cost. If the treatments meet or exceed anticipated levels of cholesterol reduction, the negotiated price remains in place, Cigna said.
Cigna declined to disclose the specific prices negotiated, or level of LDL reduction it will use to determine if further discounts are in order. In extensive clinical trials, the drugs reduced LDL by 60% or more. Health insurers and PBMs typically negotiate rebates and discounts with drugmakers of between 20% and 30% off list price but they are not usually disclosed.
Regeneron’s head of commercial operations, Robert Terifay, said he expects insurers to increasingly use value analyses to determine payment for many chronic conditions, including asthma and heart disease. He said Regeneron had signed deals with other payers to assess the value of Praluent, but declined to identify them.
The drugmakers have reported meager sales of Repatha and Praluent, injectable biotech drugs called PCSK9 inhibitors, as insurers have been slow to approve customers seeking the treatments.
Monday, May 16, 2016 / Vol. 24 / No. 19