Pharmacy Benefit Manager

PCSK9 Sponsors, Payers In The Ring At ACC

Posted on Thursday, April 14, 2016

Cardiologists bemoaned high cost of new drugs and high hurdles for reimbursement at the American College of Cardiology annual meeting; will outcomes data save the day? The Pink Sheet, April 11, 2016, By Emily Hayes / Email the Author / View Full Issue Sponsors of the PCSK9 inhibitors have been having a hard time fighting their way into the cholesterol market in their first year of launch. Cardiologists are wary of high prices for new drugs and payers have reportedly created an obstacle course for the doctors who are on board. The build-up of investor excitement over anti-PCSK9 monoclonal antibodies in the post-Lipitor era was fast and heavy, despite some awareness early on in their development of the risks of launching injectables in a market dominated by oral generics (“Will New Injectables Sell In An Oral, Mainly Generic Cholesterol World?” — “The Pink Sheet,” Apr. 9, 2012). With high LDL-lowering potency, good tolerability and a genetically based mechanism of action that is similar to statins, the PCSK9 class looked like a game-changer in cholesterol reduction, despite all of the available generics, especially without outcomes data (“PCSK9 Mechanism Lends Confidence Ahead Of Outcomes Data” — “The Pink Sheet,” Mar. 23, 2015). But performance of Amgen Inc.’s Repatha (evolocumab), approved in August...

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How Can Migraine Drugmakers Avoid the PCSK9 Debacle?

Posted on Friday, April 8, 2016

The Timmerman Report, By Luke Timmerman, April 4, 2016 One of the big ideas in biotech today is that you can prevent severe, chronic migraine headaches. This story has a lot of juicy ingredients: intriguing biology, bona fide medical value, and a potentially broad impact on millions of people. But if the drugmakers in this emerging category overplay their hand, and don’t pay careful attention to the new drug pricing reality, it could become a train wreck. Think about the PCSK9 drugs. Not long ago, biologists and cardiologists were raving about the cholesterol-lowering power of these antibodies from Amgen and Sanofi/Regeneron Pharmaceuticals. Both drugs won FDA approval to much fanfare last summer. Months later, sales of these drugs are barely a rounding error for either company. The vast majority of prescriptions (about 75 percent by estimates from Amgen) are being denied by payers via prior authorization procedures. And the denials keep coming on appeal. Payers want to see whether these $14,000 list-priced drugs are any better than cheap generic statins at what really counts – reducing heart attack and stroke. Until cardiovascular outcomes data rolls in from clinical trials in 2017, and data accumulates on their long-term safety, payers have tucked these drugs in a tidy little box. They...

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Medicaid May Offer Best Opportunity For Merck’s Zepatier

Posted on Wednesday, April 6, 2016

Newest hepatitis C entrant doesn’t have the best value in all subpopulations, according to analysis by Real Endpoints, but Medicaid’s mandatory discount could make up for those disadvantages. The Pink Sheet, March 28, 2016, By Cathy Kelly / Email the Author / View Full Issue Merck & Co. Inc.may find the unique drug pricing rules in Medicaid help create the best opportunity for its recently approved hepatitis C drug, Zepatier (grazoprevir/elbasvir), relative to prospects in the commercial and Medicare Part D markets. Zepatier is the third all-oral hepatitis C combination drug to reach the market and it has a narrower label than Gilead Sciences Inc.’s market-leading Harvoni (sofosbuvir/ledipasvir). To compensate for those challenges, Zepatier is positioned to compete mainly on price. Its wholesale acquisition cost is $54,600 for a treatment regimen, approximately 30% below Harvoni’s list price (“Merck’s Biggest Impact With Zepatier Approval May Be On HCV Pricing” — “The Pink Sheet,” Feb. 1, 2016). A recent analysis by RealEndpoints’ drug value and pricing tool RxScorecard highlights the complicated considerations that go into commercial strategies across the three major markets – Medicare, Medicaid and commercial plans – and shows how the pricing rules governing one sector, Medicaid, might offer advantages that the others do not. Merck is not indicating that its primarily focus for Zepatier will be Medicaid. The company told...

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A tale of two new hepatitis C drugs

Posted on Thursday, March 10, 2016

Despite discount, Merck’s just approved Zepatier unlikely to win share with most US payers, except in Medicaid, according to RxScorecard™.  New combo from Gilead could ensure company’s dominant position among US payers. Westport, CT, March 10, 2016 It can take more than a big discount to get payers to buy into a new drug. Although Merck is launching its new hepatitis C virus (HCV) medicine, Zepatier, at an approximate 30% discount to the “list” price of the overwhelming market leader, Gilead’s Harvoni, RxScorecard™ analysis shows that it is unlikely to make significant headway in most commercial and Medicare plans. Meanwhile, RxScorecard™ shows that Gilead’s sofosbuvir/velpatasvir (SOF/VEL) combination, likely to be approved this summer, could be a big winner, obsoleting Gilead’s own Harvoni, as Harvoni sidelined Gilead’s first entry, Sovaldi. But SOF/VEL will succeed only if it matches the discounting Gilead is providing with Harvoni. Real Endpoints LLC (RE) came to these conclusions based on its proprietary tool RxScorecard™, which assesses the relative value of marketed and pipeline drugs from a payer’s point of view. RE defines value as a full assessment of a drug’s efficacy, safety, convenience, adherence and economic attributes in comparison to other therapies in the indication. The HCV market has been enormously attractive to drug companies. According...

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Real Endpoints’ RxScorecard™ predicted launch failure of major new anti-cholesterol drugs

Posted on Thursday, February 11, 2016

Analysis from 2015 showed that because PCSK9 inhibitors had not proved more than incremental value for most patients, payers would dramatically restrict their usage. Poor Q4 sales show that’s exactly what happened. Westport, CT, February 11, 2016 In a press release issued July 7, 2015,  Real Endpoints LLC (RE) predicted that the two soon-to-be-launched PCSK9 inhibitors from Amgen and Regeneron/Sanofi would not get substantial market uptake. RE based this conclusion on its proprietary tool RxScorecard™, which assesses the relative value of marketed and pipeline drugs from a patient’s and payer’s point of view. RE defines value as a full assessment of a drug’s efficacy, safety, convenience, adherence and economic attributes in comparison to other therapies in the indication. RxScorecard indicated that while both products offered potential efficacy benefits, they demonstrated little incremental value for most patients because of their lack of meaningful outcomes data at launch and their expected high pricing. As a result RE said last July that “Payers will have an extraordinary opportunity to control costs in this class.” That’s exactly what they did. Now that Q4 sales are in for both Praluent and Repatha, the magnitude of their launch failure is clear. Praluent sold only $7 million in Q4; Amgen has not released data on Repatha,...

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Who Has the Power to Cut Drug Prices? Employers.

Posted on Tuesday, December 1, 2015

Harvard Business Review, December 1, 2015 by Robert Galvin, MD and Roger Longman Why do medications cost so much, particularly specialty drugs that treat the most serious conditions? Mostly because U.S. drug companies can price them however they want. But pharmaceutical companies don’t deserve all of the blame for high drug prices. Lots of other actors in purchasing, distribution, and brokerage have greater incentives to keep prices high than to lower prices or choose drugs that reduce longer-term medical and business costs, like absenteeism.  Employers have the greatest potential to influence some of those actors and, ultimately, to chip away at high drug prices. But to appreciate the power that employers have in this area, you must first understand how competing incentives work in the world of drug pricing. Click here to read full...

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‘DrugAbacus’, a Comparative Cancer Drug Pricing Platform Powered by Real Endpoints’ RxScorecard™, is Launched

Posted on Friday, June 19, 2015

Westport, CT, June 19, 2015 – Real Endpoints (RE) is pleased to announce that its RxScorecard™ is the information technology platform supporting Memorial Sloan Kettering Cancer Center’s DrugAbacus – an interactive tool for considering the basis of cancer drug prices. Conceived by Dr. Peter B. Bach, Director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering (MSK), DrugAbacus was launched at MSK’s DrugAbacus generates a dollar-value for cancer drugs available in the United States (beginning in 2001 with Gleevec) based on a user’s settings for six different domains of potential value including the treatment’s survival benefit, side effects, and the incidence of the condition targeted. Memorial Sloan Kettering licensed the Real Endpoints RxScorecard platform for research purposes so users can generate “Abacus prices” and compare them with actual prices of these drugs at the time of launch in a visual and intuitive format. “We believe RxScorecard is the only tool available that provides a 360 degree comparison of the multiple components of a drug’s value in an independent, objective and systematic approach. We developed the IT platform to make it very easy for users to access our analysis, and are delighted that Dr. Bach selected this platform for DrugAbacus,” said Julie Eskay Eagle, RE’s Vice...

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Wall Street Journal publishes article on new cancer pricing tool from Memorial Sloan Kettering using RE’s RxScorecard technology

Posted on Friday, June 19, 2015

June 19, 2015 – Memorial Sloan Kettering Cancer Center, one of the nation’s top cancer hospitals, has created an interactive calculator that compares the cost of more than 50 cancer drugs with what the prices would be if they were tied to factors such as the side effects the drugs produce, and the amount of extra life they give patients. Please click here to access the article....

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The Healthcare Round-up: July 30-Aug 3

Posted on Friday, August 3, 2012

Competition’s the theme for this week’s round-up, brought to you from Olympic city, London. While the world’s best and fastest athletes battle it out for gold (checked periodically for performance-enhancing drugs by our friends at GSK), so the competition’s hotting up among health insurers and providers, too — at least if (some) politicians get their way. The goal: ultra-efficient, cost-effective medical care. In Europe’s engine-economy, Germany (current Olympic medal-count: 18) the government’s pushing for more competition among the statutory health insurers, which are currently enjoying a surplus. As we reported earlier this week, more transparent pricing (and thus more consumer switching) has already sharpened up the country’s 150 or so SHIs. Tighter anti-monopoly laws could lead to an almost US-style free market — with both payers and pharma under pressure to deliver cost-effective solutions. Not that the health care system in the US (current medal count: 37) is a great example of market-competition-driven efficiency. If it were, it wouldn’t be facing lawsuits like that against Blue Cross and Blue Shield in Alabama, accused of conspiring with other Blues plans to avoid competition, thus driving up costs. This kind of behaviour — plus underlying structural issues — is why the US system is rapidly becoming unsustainable. That was the common message...

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