Express Scripts: Fight against cancer drug prices 'much bigger' than hep C

Express Scripts ($ESRX) has been warning about a crackdown on cancer drug spending. Now, it's talking about how.

The good news for pharma: It's not going to be a quick-hit, drama-filled operation like the hepatitis C negotiations that wrung 40% discounts on the pricey new-generation treatments.

The bad news: In the long run, it's still going to be painful.

Express Scripts CMO Steve Miller

"This is going to be a much slower and much bigger effort over time than what you saw for hepatitis," Chief Medical Officer Steve Miller said during the company's Q1 earnings call (as quoted by Reuters). "Cancer is different than any other disease, much more emotional."

Miller is talking about incremental changes, rather than one-fell-swoop cuts. He's also talking about using data and other tools to keep a lid on cancer costs.

That may mean changing the order in which pricey cancer drugs are used. It may mean relying on a single expensive drug at a time when combo therapy offers marginal benefits. And it could mean that some drugs actually are used more--while others are used less.

The fact that Miller is talking about a "slower" effort doesn't mean it's not imminent. In January, Miller told Bloomberg that Express Scripts wants to see results by next year. "We want to be able to start influencing the market by 2016," he told the news service. "We are accumulating all the keys to the puzzle to be able to do this."

Ironically enough, Miller's comments come on the heels of some pharma earnings reports that include big sales for expensive new cancer drugs. Merck & Co.'s ($MRK) Keytruda is off to a roaring start with $83 million in Q1 sales, and the $150,000-per-year melanoma drug is up for a much bigger use in lung cancer.

Rival Bristol-Myers Squibb ($BMY) already won a second nod in lung cancer for Opdivo, which brought in $40 million for the quarter; it's also a $150,000-per-year med. And Pfizer's ($PFE) Ibrance, launched in February for relapsed breast cancer at $9,850 per month, brought in $38 million in what was left of the first quarter, and it's already making inroads for first-line use.

And these are just three of the newest cancer drugs on the market; as Reuters points out, Amgen's ($AMGN) Blincyto for a rare form of leukemia has a list price of $178,000.

- see the Reuters news

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