When 2 out of 3 is bad: Teva migraine drug gets sidelined in second PBM's formulary

UnitedHealthcare
UnitedHealthcare's PBM selected Amgen and Eli Lilly CGRP drugs for its preferred coverage list. (UnitedHealth Group)

Amgen and Eli Lilly's next-gen migraine drugs just won the prize in another formulary joust. UnitedHealthcare's pharmacy benefits outfit OptumRx chose their drugs for its preferred coverage list, Reuters reported, citing an OptumRx coverage note. 

And that leaves Teva with its second defeat. The company's CGRP drug Ajovy didn't make either of OptumRx's preferred formularies. Patients can still access Teva’s Ajovy, but they would have to pay more. 

OptumRx’s selection comes as the drugmakers fight for market share in the new class of migraine prevention drugs known as CGRP inhibitors. Partners Amgen and Novartis won the initial nod in the field with Aimovig last May, and Teva and Eli Lilly each followed with September FDA approvals. Each drug carries a list price of $6,900 per year. Amgen and Novartis set initial pricing, and their rivals followed suit.

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Teva estimates payer formularies give more than 60% of U.S. commercial patients access to Ajovy, a company spokeswoman said via email, and the company's discussion to improve patient access are continuing. Ajovy moved Friday from excluded to nonpreferred on OptumRx’s National Commercial Formularies and continued on the nonpreferred tier for Optum Select and Optum CTRX Select Formularies.

All patients with commercial insurance can use Teva's copay assistance program to pay "as little as $0" for Ajovy.

"Teva’s Shared Solutions program is also committed to helping patients gain access to AJOVY with a team available to research and understand patients’ coverage and benefits," she said.

RELATED: CVS puts Amgen's Aimovig in back seat behind Teva, Lilly migraine drugs 

OptumRx's decision represents the third major coverage selection by a U.S. PBM giant for the drugs. Express Scripts, now part of insurance giant Cigna, made its initial decision on the new drugs back in October—quickly after September approvals for Ajovy and Emgality. The PBM chose to cover Amgen and Lilly drugs on its preferred list and excluded Teva altogether.

CVS Caremark, on the other hand, put Amgen’s Aimovig behind its two rivals in its decision unveiled last week. With the decisions, Eli Lilly's Emgality has preferred coverage with all three PBM giants, while Amgen’s Aimovig scored preferred coverage with UnitedHealthcare’s OptumRx and Express Scripts. Teva’s Ajovy only scored preferred coverage on CVS’ formulary.  

Representatives for Optum didn’t immediately respond to a request for comment on the latest coverage decision.

The drugmakers each face different challenges, but the launches are important for all three. Amgen reported Aimovig sales of $119 million in 2018, while Eli Lilly and Teva haven't yet reported fourth-quarter results.

RELATED: Amgen, Lilly migraine drugs nab Express Scripts backing, but Teva's shut out 

On a conference call last week, Amgen EVP of global commercial operations Murdo Gordon said Aimovig "reached over 150,000 patients during 2018” and is on a “strong launch trajectory.” Gordon said the company “priced this product for access” and that it’s “been well received by payers for the most part."

“What's happened to date has been that we've received pretty good coverage with most payers even on a noncontracted basis allowing the product to be reimbursed on the basis of physician attestation alone,” he said on the call. 

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