While health plans and PBMs have taken a variety of approaches to control spending on the new class of cholesterol fighting drugs, Cigna is the first to reach value-based agreements with the drug makers.
The health insurer Cigna has reached agreements with makers of both approved versions of the new cholesterol-fighting class PCSK9 inhibitors, which will align payment with how well patients respond to the drugs.
Amgen, which makes evolocumab (Repatha), and Sanofi-Regeneron, sponsor of alirocumab (Praluent), both won FDA approval for this breakthrough therapy class last summer. Both injectable drugs came on the market at costs above $14,000 a year per patient, a level that exceeded analysts’ expectations.
In response, health plans and pharmacy benefits have taken a variety of steps to control spending on the drugs; Express Scripts negotiated discounts for both, CVS Health struck an exclusive deal for evolocumab, and all payers have protocols that ensure only the most high-risk patients and those with genetic conditions that elevate LDL cholesterol gain access to therapy.
Cigna, however, is the first payer to take a value-based approach to cost control. In a statement announced today, it said it had reached separate agreements with the 2 pharmaceutical sponsors with a similar purpose: “If Cigna’s customers aren’t able to reduce their LDL-cholesterol levels at least as well as what was experienced in clinical trials, the 2 pharmaceutical companies will further discount the cost of the drugs,” the statement said. “If the drugs meet or exceed expected LDL cholesterol reduction, the original negotiated price remains in place.”
Clinical trials have shown that PCKS9 inhibitors can reduce low-density lipoprotein (LDL) or “bad” cholesterol by up to 60%, depending on the cause of elevated cholesterol and whether patients are also taking metformin.
Cigna stated further that an analysis of claims data and electronic health records will reveal whether there are cardiovascular improvements for their enrollees based on PCSK9 treatment, beyond reduced cholesterol. This is important, because one of the questions about these new drugs will prevent cardiac events such as heart attacks or strokes in addition to lowering LDL cholesterol.
FDA approvals, in fact, did not go as far as those in Europe because regulators here want to see results of long-term cardiovascular outcomes trials, which will not produce results until 2017.
Cigna’s statement said the insurer, which await approval of a proposed merger with Anthem, now has value-based contracts in place for therapies that treat heart failure, diabetes, multiple sclerosis, and hepatitis C virus.