Striking a ‘Grand Bargain’ for a PCSK9 Inhibitor

On May 1, 2018, Regeneron/Sanofi and Express Scripts announced  an agreement to improve affordability and access for the PCSK9 inhibitor alirocumab (Praluent). As part of the arrangement, Express Scripts will pay a net price consistent with the value-based price benchmark ICER established earlier this year, alirocumab will receive exclusive placement on Express Scripts’ national formulary, physicians will face fewer administrative hurdles when prescribing the treatment, and the financial savings will be shared directly with the patients. More on the agreement is available from Express Scripts, Regeneron, and Sanofi.

In response, ICER issued the following statement:

“Following a decades-long trend toward dysfunction and finger-pointing, the US health care system is beginning to address its drug pricing problem through the emergence of a ‘grand bargain.’ When a manufacturer is willing to responsibly price an innovative medicine in line with its clinical benefits, payers should reciprocate by removing the hurdles that can prevent patients from getting the drug. We commend the Regeneron and Sanofi team for seeking ICER’s independent assessment on what a fair, value-based price would be for Praluent, and we endorse Express Scripts’ decision to make it financially and administratively easier for eligible patients to access this life-saving therapy. As the nation strives to help all Americans achieve sustainable access to high-value care, this sort of grand bargain – a win-win-win for manufacturers, payers, and patients – is a model for the rest of the industry to contemplate.”

The announcement was covered by multiple media outlets, including Bloomberg, ForbesCNBC, Reuters,  STAT News, and Xconomy. Notable excerpts:

  • “Today’s agreement marks a ‘continued evolution’ of the national dialogue, [Steve Miller, Chief Medical Officer of Express Scripts] says, citing how Regeneron voluntarily worked with ICER. ‘We are already in discussions with others about doing things similar to this,’ Miller says. ‘We think this is a great model as we go forward.’” – Xconomy
  • “I hope that this will spread like wildfire through the entire payer system,” [Leonard] Schleifer said. – Reuters
  • “We think this is a new model,” Miller said. “You’ve got a company that looks at what fair drug price is, puts itself through an external evaluation, and then negotiates on that price with us. We believe that this can actually change the marketplace.” -STAT News
  • “‘I hope the world will take notice and other payors will follow and other drugs will follow,’ Schleifer says. ‘Because there is no point in us discovering all these things if we can’t figure out a way to get them to patients, get them paid for, and have adequate incentive for the people funding this research.’” – Forbes