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CVS makes exclusive deal to cover Amgen’s cholesterol drug

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(Bloomberg) — CVS Health Corp.’s drug-benefits unit will cover Amgen Inc.’s new cholesterol-cutting injections while excluding a competing treatment from Sanofi (NYSE:SNY) and Regeneron Pharmaceuticals Inc. (Nasdaq:REGN), pushing for savings from medications that list for more than $14,000 a year.

The decision, which applies to workers whose employers use CVS Health (NYSE:CVS) for drug coverage, shows that benefit managers are continuing to be aggressive about setting exclusive deals with drugmakers to get better prices for expensive new therapies.

CVS said that its independent pharmacy and therapeutics committee had reviewed data for Amgen’s Repatha, as well as Praluent from Sanofi and Regeneron Pharmaceuticals, and concluded that the drugs were clinically equivalent.

See also: Amgen’s cholesterol drug recommended by European regulator panel

“That puts us in a situation where we can bargain with the drug manufacturers” and get a significant discount in return for an exclusive deal, said Troyen Brennan, CVS’s chief medical officer, said in a phone interview. “You have to use every tool that you have to try to keep costs down today.”

While the discount CVS obtained from Amgen (Nasdaq:AMGN) was “substantial,” Brennan said he would not reveal the amount or the length of the contract with Amgen. CVS will continue to require that prescriptions for Amgen’s drug be approved in advance, a practice known as prior authorization that can limit use of the medicine.

Amgen shares rose 1.8 percent to $162.74 at 9:59 a.m. in New York. Regeneron was up less than 1 percent to $582, and Sanofi fell less than 1 percent to 82.75 euros.

Hepatitis competition

CVS’s decision is just the latest example of pharmacy benefit managers excluding some expensive drugs from coverage in a category in order to gain better prices for the competing drugs they do decide to cover.

Last December, Gilead Sciences Inc.’s hepatitis C treatment Harvoni was excluded from Express Scripts Holding Co.’s main list of 2015 covered drugs in favor of a competing treatment from AbbVie Inc. That move set off a price war over hepatitis C drugs, with several other insurers and payers, including CVS, deciding to cover only the Gilead medicine.

Winning an exclusive deal with a benefits manager is a mixed blessing for drugmakers, who ensure a market for their drugs but may sacrifice a lot in discounts. AbbVie’s hepatitis C treatment generated $469 million in sales last quarter, while Gilead’s drugs, which require patients to take fewer daily pills, brought in $4.8 billion.

Bad cholesterol

PCSK9 inhibitors are designed to help people with high levels of bad cholesterol who can’t get their condition under control with statins such as Pfizer Inc.’s Lipitor. Payers of insurance benefits have worried they could become one of the costliest drug classes ever, with the potential for $100 billion in annual sales if widely used. For now, their scope is more limited to people who have genetic conditions or particularly stubborn cholesterol levels.

See also: Sky-high genetic cholesterol primed for blockbuster drug

Brennan said CVS was thinking about how to control costs of the PCSK9 drugs over the long term.

While usage now is modest, large clinical trials examining whether the therapies can lower rates of heart attacks and other cardiovascular events could have results next fall, he said, leading to wider use.

“It is going to be a long game here,” Brennan said. “So far we have been very pleased with what we have seen in terms of ability to control the utilization.”

CVS said its decision is effective on Dec. 1. Overall, CVS manages drug coverage for 70 million Americans, but the company doesn’t break out how many are on the company’s commercial coverage lists, spokeswoman Christine Cramer said in an e-mail.

Amgen said it was “delighted” with the choice. “We will continue to engage constructively with other payers to enable patients to have access to Repatha,” Anthony Hooper, Amgen’s head of commercial operations, said in a statement Monday.

“Sanofi and Regeneron are disappointed about the decision CVS made in limiting access to Praluent,” the two companies said in a joint statement. “Patients and physicians should have a choice regarding their treatment and access to the right therapy to meet individual patient needs.” Sanofi and Regeneron are in ongoing discussions with other insurers over Praluent coverage, according to the statement.

‘Small percentage’

In October, Express Scripts (Nasdaq:ESRX), the largest manager of prescription drug benefits for employers and insurers in the U.S., said it would cover both Praluent and Repatha. It was the first major coverage decision for the drugs on a national basis in the United States.

See also: Amgen, Sanofi cholesterol drugs covered by Express Scripts

Sanofi and Regeneron’s drug Praluent won approval from U.S. regulators on July 24, while Amgen’s PCSK9 drug Repatha was approved on Aug. 27. Since then, doctors, patients and investors have been speculating on how insurers would cover the drugs and what restrictions would be imposed on their use.

In its statement, CVS said that for most patients with high cholesterol, statin drugs will remain the standard of care. The PCSK9 drugs are necessary for “a small percentage of patients” who can’t achieve their treatment goals with other therapies, it said.

—With assistance from Caroline Chen.