NEW YORK (Good Medical) – One of America's leading drug plan sponsors (PBM) belonging to UnitedHealth Group Inc. has included new migraine drugs from Amgen Inc. and Eli Lilly and Co among the treatments of choice on its drug coverage lists, according to an OptumRx customer note consulted by Good Medical.
FILE PHOTO: Lilly's logo is visible on a wall of the Lilly France business unit of the Eli Lilly and Co group, drug manufacturer, in Fegersheim near Strasbourg, on February 1, 2018. Good Medical / Vincent Kessler
The precursor of migraine, rival of Teva Pharmaceutical Industries Ltd, is excluded on a list and patients can pay more, in some cases, on a second list, said the note.
As with competing Express Scripts PBMs and CVS Health Corp, OptumRx's Covered Drug Formulary lists cover tens of millions of consumers who benefit from health care provided by their employers and their health insurers.
According to the Migraine Research Foundation, about 39 million Americans suffer from migraine headaches, and global sales of anti-migraine drugs could reach $ 8.7 billion by 2026, according to the consulting firm. GlobalData.
OptumRx's decision simplifies access to Lilly's Emgality customers on the three largest PBMs – including CVS and Express Scripts – and gives Amovig Aimovig a boost after CVS decides not to list it on its website. list of preferred drugs.
Teva Ajovy has only the privileged status at CVS, while Amgen also has it at Express Scripts, which is part of Cigna Corp.
"We are delighted that the three companies have chosen Emgality as one of the preferred drugs, making it accessible to even more migraine patients," Lilly said in a statement.
The inclusion on a list of preferred medications by the largest PIMs and health insurers is of crucial importance for the sale of new drugs. PBMs are increasingly choosing a subset of treatments for their coverage list when multiple treatments are considered equivalent.
The three treatments, approved by the US Food and Drug Administration last year, belong to a class of drugs called CGRP inhibitors that have been shown to be effective in helping to prevent migraine headaches.
A spokeswoman for Teva said the company was committed to increasing access to Ajovy regardless of the decisions regarding the form and that it still offered discounts allowing patients to stay away from anything pay in some cases regardless of insurance.
"Since Ajovy's injection launch in September, we have experienced strong demand and steady growth, and we are continuing discussions with payers," said the spokesperson.
A spokeswoman for Amgen said the company was pleased with the decision and pledged to ensure affordable access to her drug.
Amgen, which shares Aimovig US's revenue with Novartis AG, reported $ 95 million in revenue in the fourth quarter, nearly double the estimates on Wall Street.
The OptumRx decision comes into effect on February 1 st.
The OptumRx selection form relegates Teva's drug to a lower level of access that would typically require a higher cost, he added.
PBMs typically receive discounts from drug manufacturers in exchange for a favorable ranking on their preferred drug coverage list, for example through a low co-payment, or co-insurance payment, for their members.
The three migraine medications have a list price of $ 575 a month, or $ 6,900 a year. These prices do not include rebates and rebates granted to PBMs who design and negotiate benefits for employers and insurers.
The three drug manufacturers provide patients with free time-limited supplies of new drugs, in addition to other assistance programs.
Amgen's Aimovig was the first on the market for the new class. But rivals Teva and Lilly followed soon after.
The Big Three PBMs cover the majority of the more than 150 million Americans who receive benefits through their employers. Their clients, including insurers and businesses, may choose not to follow a PBM's recommendations on coverage, but it would usually be more expensive.
Amgen shares lost 28 cents to 186.63 dollars, Lilly rose nearly 1% to 120.90 dollars and shares of Teva in New York lost nearly 1% to 19.69 dollars.
Reportage of Caroline Humer; Edited by Jeffrey Benkoe and Bill Berkrot