(Bloomberg) — Health insurers are grappling with the question of whether to cover the new pink pill to treat low libido in women, which will hit U.S. pharmacy shelves this year with a prominent warning label for serious side effects such as fainting.
Anthem Inc. (NYSE:ANTM), the third-largest health insurer in the country, said Wednesday it will cover Sprout Pharmaceuticals Inc.’s Addyi in many cases. Insurer Cigna Corp. (NYSE:CI) and drug benefits managers including Express Scripts Holding Co. (Nasdaq:ESRX) and CVS Health Corp. (NYSE:CVS) said they’ll evaluate what to do over the next few weeks.
Getting coverage from insurers is crucial for Sprout, which has fought to get FDA approval for Addyi after the agency rejected the drug in 2010 and 2013. Without help from insurance plans, women will have to consider paying as much as $400 a month for the chance to see whether the drug will work for them. Sprout said Addyi should get reimbursed at the same rate as male sexual-dysfunction drugs.
“Seventy percent of men with insurance have those covered,” Sprout Chief Executive Officer Cindy Whitehead said in an interview on Bloomberg Television. “We would expect parity coverage.”
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Insurers will focus on the safety and effectiveness of Sprout’s treatment, also known as flibanserin, which was approved for premenopausal women who want to boost their sexual desire.
Women who participated in clinical trials on Addyi experienced on average 0.5 to one more satisfying sexual experience than those on placebo. Yet the risks include drops in blood pressure and fainting, dangers that are enhanced by alcohol.
Anthem has placed Addyi in its third tier, meaning it will cost patients more than they’re charged for generic medications or preferred brand-name treatments. Anthem also puts the male sexual dysfunction drugs Viagra and Cialis in tier 3.
“Coverage varies by state and by plan as lifestyle drugs are not typically part of the standard benefit,” Kristin Binns, a spokeswoman for Anthem, said in an e-mail.
The other four largest U.S. health insurers didn’t have an immediate comment on their coverage plans. Sprout expects most insurers to put the drug in tier 2 or 3 on their formularies with a $30 to $75 copay.
Express Scripts, the largest U.S. pharmacy-benefit manager, will have a coverage recommendation in the next few weeks after Addyi is reviewed by pharmacy advisers, David Whitrap, a spokesman, said in an e-mail. CVS Health and Prime Therapeutics LLC also will wait for advisers to review the drug before making a coverage decision, according to e-mails from both companies.