Wary Vertex preps payers for its pricey new CF treatment

Vertex ($VRTX) is on the verge of something very big with lumacaftor, a drug that could revolutionize cystic fibrosis treatment for nearly half the world's patient population. But as it awaits approval and looks ahead to launch, it's taking care to avoid the payer pushback Gilead ($GILD) sparked with its pricey next-gen hep C med Sovaldi.

Like the Gilead pill--whose $84,000-per-treatment-course price tag ignited the ire of payers, patients and healthcare providers alike, despite its unprecedented cure rates--Vertex' newcomer will be pricey. And on last week's Q4 conference call, Chief Commercial Officer Stuart Arbuckle seemed to be prepping payers for the blow, the Boston Business Journal notes.

Stuart Arbuckle

Vertex is "investing in disease education to help payers estimate the number of eligible patients they may have in their plans," he told analysts. Considering that lumacaftor--combined with Vertex' first CF drug, Kalydeco--could benefit 8,500 U.S. patients age 12 and older with a mutation dubbed F508del, that could be a large number. And while lumacaftor is expected to ring in at a lower cost than Kalydeco thanks to its larger patient population, it'll no doubt weigh on payers at a time when drug pricing is in the national spotlight.

But unlike Gilead's hep C drugs, which from the get-go had a gaggle of competitors heading down the pipeline, Vertex will be running its market solo for the foreseeable future. That means it'll be free of the price war that's enveloped Gilead and rival AbbVie ($ABBV), which touched off the battle by negotiating an exclusive position with PBM giant Express Scripts ($ESRX).

That's good news for the Cambridge drugmaker, which believes the lumacaftor launch could help it reach 10 times as many patients as Kalydeco currently does. Still, Vertex--no stranger to price criticism itself, with its $311,000-a-year Kalydeco sticker having raised plenty of eyebrows--is playing it safe.

In addition to educating payers, the company will scale up its patient services team ahead of its July 5 PDUFA date, Arbuckle said on the call. That way, "we can help providers and patients navigate the reimbursement process and also help with patient education and compliance."

- read the call transcript from Seeking Alpha
- get more from the BBJ

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