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CVS joins Express Scripts in targeting new cholesterol drugs

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(Bloomberg) — CVS Health Corp. (NYSE:CVS), the second-biggest manager of prescription drug benefits in the U.S., will make a new class of injectable cholesterol treatments its next major target to push back against high drug costs.

The drugs, called PCSK9 inhibitors, belong to an experimental class of medicines under development by Amgen Inc., Pfizer Inc., and Sanofi and Regeneron Pharmaceuticals Inc. They can cut levels of LDL, or bad, cholesterol dramatically, benefiting people who can’t take other cholesterol medicines or who can’t get their levels low enough.

They may also cost $7,000 to $12,000 a year and patients could be on them for life, adding significant expense to the medical system, CVS executives warned.

“With a robust pipeline of expensive specialty drugs this is just the beginning, and the resilience and ability of our health care system to absorb such high costs will be tested if rigid cost-control mechanisms are not put in place,” William Shrank, chief scientific officer at CVS, said in a statement.

These cholesterol drugs are the latest part of a broader effort by pharmacy benefit managers (PBMs) to push down the cost of new drugs. Express Scripts Holding Co. Chief Executive Officer George Paz said in January that PCSK9 inhibitors will be the next opportunity to pit drugmakers against each in order to force prices down. Express Scripts is also setting its sights on cancer medications, where the latest drugs can cost as much as $150,000.

Major players

Express Scripts (Nasdaq:ESRX) has about 30 percent of the U.S. pharmacy benefits management market, and CVS about 27 percent, according to Robyn Karnauskas, an analyst with Deutsche Bank.

The first patients to use the PCSK9 drugs are likely to be those who have a form of high bad cholesterol caused by a genetic variation that affects about 620,000 Americans. Once the drugs are approved for broader use, the population taking them could grow to as many as 15 million, according to CVS.

Defenders of the proposed prices for the new drugs argue that developing new drugs is enormously expensive, and that successfully using the drugs to prevent strokes and heart attacks could reduce spending on acute health care and long-term care (LTC) services, as well as improving patients’ quality of live and reducing the loss of work productivity associated with high cholesterol levels.

But the total costs of the PCSK9 inhibitors, and the strain on the finances of the health system, could be much greater than from Gilead Sciences Inc.’s hepatitis C drug Sovaldi, which first hit the market at $84,000 for a course of treatment.

“Like the hepatitis C treatments, PCSK9 inhibitors represent a significant advance in treating intractable diseases — convenient and highly effective with few side effects,” Troyen Brennan, CVS chief medical officer, said in the statement. “But they also pose a much more complex financial dilemma since, unlike the hepatitis C treatments which offer a cure in as little as 12 weeks, PCSK9 inhibitors will be prescribed as ongoing maintenance therapy for the duration of patients’ lives.”


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