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Express Scripts Sees Opportunity to Lower Cost of Cancer Treatments

Pharmacy benefit manager pits drug-makers against each other

Express Scripts, the largest pharmacy benefit manager in the U.S., has announced that cost savings on expensive cancer treatments could be achieved if the company were involved earlier in the decision-making process.

Last December, the group stopped covering Gilead Sciences’ expensive hepatitis C drugs Sovaldi (sofosbuvir) and Harvoni (ledipasvir/sofosbuvir) after negotiating a lower price for AbbVie’s newly approved alternative, Viekira Pak (ombitasvir, paritaprevir, and ritonavir tablets; dasabuvir tablets). Express deemed the more than $90,000 price tag for 12 weeks of Harvoni treatment unaffordable. Gilead responded to the decision by winning its own exclusive deals with CVS Health Corp. and Anthem Inc.

On January 12, Prime Therapeutics, which manages medications for non-profit Blue Cross and Blue Shield plans, said it didn’t bother negotiating a discount with Gilead or AbbVie because the costs for both companies’ hepatitis C drugs had fallen so much below their list prices. Before discounts, Sovaldi costs $84,000 for a 12-week course of treatment, and Harvoni costs $94,500 for 12 weeks. The listed 12-week price for Viekira Pak is $83,319.

PCSK9 inhibitors, a highly anticipated class of medications that reduce cholesterol, will be the next big opportunity to pit drug-makers against each other to reduce costs, Express Scripts Chief Executive George Paz said at a health care conference in San Francisco. He remarked that he is already talking to companies about market share, positioning, and pricing. Manufacturers include Amgen and Regeneron Pharmaceuticals Inc in partnership with Sanofi. The key is to determine which are real breakthrough treatments and which are “me too” drugs, Paz said.

Express Scripts is also looking ahead to high-priced cancer drugs after it tackles the cholesterol market.

For cancer patients, treatment decisions typically go through health insurance plans first, and medications are not changed once people have begun their regimens. Paz said pharmacy benefit managers should be included in the decision-making process at a much earlier stage.

Amgen’s leukemia drug Blincyto (blinatumomab) will cost $178,000 for a standard course of treatment, the company said last month. Merck plans to charge about $150,000 a year for its melanoma drug Keytruda (pembrolizumab).

Sources: Reuters; January 13, 2015; and Bloomberg; January 13, 2015.


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