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

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Lilly, Amgen and Express Scripts also agreed to an "early discontinuation reimbursement" for health plans if patients stop treatment within 90 days. (Express Scripts)

Early into their hotly anticipated migraine launches, Amgen and Eli Lilly have picked up key coverage from Express Scripts, but Teva's Ajovy was left out in the cold. 

Express Scripts chose to cover Aimovig from Amgen and Emgality from Eli Lilly—two of the three approved drugs in the nascent CGRP migraine prevention class—after price negotiations. But as the giant pharmacy benefit manager said Wednesday, it shut out Teva’s Ajovy. All three carry a list price of $6,900 per year, and negotiated discounts are confidential.

Meanwhile, Express Scripts is rolling out a program to identify appropriate patients for the CGRP drugs. And to help health plans minimize their costs for the new drugs, the drugmakers and Express Scripts will pay an “early discontinuation reimbursement” if patients stop treatment within 90 days, a spokesperson said.

Patients can secure coverage for Ajovy if it's clinically required, she said.

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Amgen won its first-in-class approval for Aimovig back in May, followed by Teva’s Ajovy and Eli Lilly’s Emgality in September. Analysts have said the migraine market could be worth billions as the players duke it out for share.

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Obviously, Express Scripts' decision is a blow for Teva, as Wells Fargo analyst David Maris wrote in a Wednesday note. It's a “clear negative" for the company, because the new drug is "Teva's highest profile growth driver and was hoped to be a bright spot for the company as it already faces a challenging generic drug market and a cost-cutting program.”
 
Maris added that it doesn’t bode well for future Teva negotiations because it shows that the other companies are “playing and discounting to win.” Express Scripts covers an estimated 100 million lives in the U.S., the analyst wrote.

When Aimovig was approved, an Express Scripts representative said Amgen was “being responsible” with its list price. Payers had warned against prices of $8,000 to $10,000 per year. Express Scripts said at the time that while there’s “serious unmet need” for migraine sufferers, not all patients will need Aimovig. The PBM will require that patients try two prior preventative options and a generic triptan before covering the newer CGRPs, Reuters reports.

Even though the new field is already crowded with three drugmakers, market watchers expect more new migraine drugs to enter the fray. Allergan on Wednesday said it plans to file for FDA approval with its oral CGRP, ubrogepant, in the first quarter of next year. Alder BioPharmaceuticals has a CGRP drug in development as well.