It's common for drugmakers to offer behind-the-scenes rebates and discounts to win coverage for their drugs. But cut list prices? That's far more rare.
Amgen, though, is doing just that with its PCSK9 cholesterol drug, whose highly anticipated launch was weighed down by its $14,000 price tag.
In what may be a first for pharma, Amgen slashed that price by 60% to $5,850 per year before rebates and discounts. The move will not only help patients actually afford their share of the cost, but challenge rivals Sanofi and Regeneron, which together sell the only other PCSK9 drug on the market, Praluent. The companies this year cut Praluent's net price to a similar level, but didn't touch the drug's list price.
Right now, 75% of Medicare patients who get a prescription for a PCSK9 drug don’t actually fill it, Amgen said Wednesday.
Amgen and the Sanofi and Regeneron duo have been duking it out in the PCSK9 field since launching their rival cholesterol drugs back in 2015. Thanks to those highly scrutinized list prices—each drug launched at a price near $14,000—along with payer hurdles, the companies were forced to pony up big rebates when patients were able to access the drug at all, limiting the reach of a once-hyped drug class.
Speaking with FiercePharma, Amgen’s executive vice president of R&D David Reese said that he’s felt an "intense frustration” at low Repatha uptake after seeing the drug's benefits clearly demonstrated in a real-world outcomes study called Fourier. He said Amgen hopes the decision will allow Medicare patients—who've been paying $350 to $370 on average per month in copays—to better afford the drug.
Amgen's EVP of global commercial operations Murdo Gordon added that the rebates the company pays to commercial insurers and PBMs have "done little to help with patient affordability,” especially for those on Medicare. The only way Amgen could fix that was to lower the list price, Gordon said.
Now, Repatha’s list price will fall around its old net price to payers.
Amgen is making discounted Repatha available by introducing new national drug codes for lower-priced options. It will continue offering the higher-priced option as long as it needs to smooth the transition, aiming to remove the more expensive product by 2020. The company will seek off-cycle or mid-cycle additions to formularies for the new option, but Gordon said that may be "administratively complex."
Amgen said the move also shows its support for the Trump Administration’s goal to lower drug prices for consumers. In May, the Trump Administration released its drug pricing blueprint, which aims to lower out-of-pocket costs and list prices, among other goals.
Amgen launched Repatha back in 2015 at a price around $14,000 per year. The drug—plus rival Praluent from Sanofi and Regeneron—carried blockbuster sales expectations, but payers put up access barriers due to concerns over costs that severely limited their launches. Last year, Repatha generated $319 million in sales.
After releasing real-world outcomes data for Praluent in March, Sanofi and Regeneron said they'd lower their net price to a range suggested by cost effectiveness group Institute for Clinical and Economic Review—$4,460 to $7,975 per year. The decision doesn't affect Praluent's list price, however.
The latest discounting move follows Gilead’s decision last month to introduce authorized generics to its own hep C drugs Epclusa and Harvoni. Under heavy competition, that drugmaker was also ponying up big rebates, and rolled out the copycats to help with patient affordability and improve access, potentially opening up new sales.
Both moves signal a major change in drug pricing dynamics. HHS secretary Alex Azar, for one, said at a hearing before taking his post that he wasn’t aware of any price reductions for brand-name drugs.
They also indicate there may have been something to President Donald Trump's comments back in May that drugmakers were looking at “massive drops” in prices. When the president said the price drops would come within weeks, industry sources told Politico they weren’t aware of such a plan. Azar followed up in July and told lawmakers that pharma companies were indeed considering “substantial and material” price cuts.