UPDATED: Sanofi's and Regeneron's Praluent wins top billing on UnitedHealth Group's formulary

Sanofi's Jez Moulding

Having learned with the pricey hepatitis C drugs how to pit drugmakers against one another to extract discounts, payers are now putting that skill to use on the new PCSK9 cholesterol fighters. In the latest deal, Sanofi ($SNY) and Regeneron's ($REGN) Praluent will be UnitedHealth Group's "preferred" drug for treating superhigh LDL cholesterol.

The partners said that UnitedHealth Group will provide preferred access to both doses for the injected Praluent through OptumRx and UnitedHealthcare across a spectrum of commercial, Medicare, and Managed Medicaid patients.

It comes less than two weeks after the drugmakers worked a similar deal with UnitedHealth's ($UNH) Oxford unit, which covers patients in the Northeast. That agreement requires patients to try Praluent first, unless they have a history of reacting badly to it. If Praluent doesn't work after 12 weeks, then they can switch to Amgen's ($AMGN) competing drug Repatha.

In lauding the deal, Jez Moulding, president of Sanofi's North America operations, said "[W]e look forward to continued collaboration with other insurers to help ensure appropriate patient access to Praluent."

While other agreements may be struck, today's announcement ties up the last of the really large payer groups. It comes a few weeks after Amgen scored a formulary exclusive with CVS ($CVS) for Repatha by offering to tie its price to its effectiveness. It has struck a similar deal with Harvard Pilgrim Health System.

Before that, Express Scripts ($ESRX) agreed to offer both Praluent and Repatha on its formulary in exchange for discounts from both. Still the move surprised some since it was Express Scripts that set off the exclusives fight in the hep C category by announcing well in advance of approval that it intended to offer AbbVie's ($ABBV) Viekira Pak over Gilead Sciences' ($GILD) Sovaldi in an effort to undercut Gilead's $1,000-a-pill price for the hep C cure.

The two PCSK9 meds are in a head-to-head battle for patients after being approved just about a month apart and priced about the same at about $14,000 per year. When the drugs were under development the expectation was for runaway sales for a drug that could further fight high cholesterol. But some now think their use may grow more slowly given a lack of data that shows that they actually provide more cardiovascular benefit and the payers' efforts to limit when and for whom they are prescribed.

- here's the announcement