CVS Health announced today that Amgen’s Repatha will be the only PCSK9 inhibitor on the CVS/Caremark formulary. This gives Amgen its first big win among the pharmacy benefits managers against Sanofi’s Praluent in the battle over the market for the powerful but expensive new cholesterol-lowering drugs. Previously Express Scripts had announced that both drugs would be placed on its formulary. At the time Express Scripts said it that it expected to control costs “with a combination of discounts and a rigorous utilization management program” for the drugs.
“We have determined that choosing a single PCSK9 inhibitor for our commercial formularies allows us to get the best price possible for clients and preserves our commitment to deliver the best care available,” said a CVS executive. The company said it had performed a careful evaluation of the two drugs and determined that they were “therapeutically equivalent.”
An important and innovative feature of the agreement is that the price of the drug will be determined at least in part by its effectiveness. In its press release Amgen described the arrangement as a “value-based partnership.”
Amgen said it would offer more companies “value-based contracts that address payers’ concerns by linking the net price of Repatha to expected LDL cholesterol reductions and anticipated appropriate patient utilization.” Earlier this month the Boston Globe reported that Amgen had struck a similar “pay-for-performance” deal with Harvard Pilgrim.
Last week the UK’s National Institute for Health and Care Excellence (NICE) said that it would not recommend Repatha for use in the country’s national health service. NICE said the drug was too expensive and had not been shown to improve long-term clinical outcomes.