The Value-Based Drug Formulary (part 2)

Gilbert Benavidez is a Policy Analyst with Boston University’s School of Public Health. He tweets at  @GBinsolidarity

Earlier I wrote about CVS’s value-based formulary management system, which includes the strategic removal of drugs from formulary, based on clinical effectiveness and cost-appropriateness and done in effort to both align drug price with value and drive down costs for payers. I also mentioned relationship CVS has with the Institute for Clinical and Economic Review (ICER). Among pharmacy benefits managers (PBMs), this type of value-based activity is not unique to CVS.

In another recent example of value-based removal from formulary, the largest PBM in the US and a CVS competitor, Express Scripts, recently cut out Amgen’s Repatha (evolocumab) in favor of Sanofi and Regeneron’s Praluent (alirocumab).

Express Scripts did this for two reasons:

  1. Express Scripts struck a deal with Sanofi and Regeneron to lower the price of Praluent to be nearly in line with ICER valuation of the drug, in exchange for quick approvals of treatment requests. (Amgen has fought back against this valuation and instead defended their price)
  2. Studies found that Praluent lowered risk of heart attack, stroke and death, while Repatha only lowered heart attack and strokes.

Express Scripts’ strategic removal is in line with rival CVS’s strategy of guiding patients toward clinically effective, cost-appropriate treatments. Express Scripts CEO Steve Miller noted that the new net price will be close to the “low end” of ICER’s valuation of Praluent ($4500-8000 per year).

The move further exemplifies ICER’s ability to influence drug prices through its value-based drug pricing method.

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