Exclusive: Top U.S. insurer to cover Amgen, Eli Lilly migraine drugs, exclude Teva

By | February 2, 2019

NEW YORK (Reuters) – A top U.S. pharmacy benefit manager (PBM) owned by UnitedHealth Group Inc has included new migraine drugs from Amgen Inc and Eli Lilly and Co as preferred treatments on its lists of covered drugs, according to an OptumRx client note viewed by Reuters.

FILE PHOTO: The logo of Lilly is seen on a wall of the Lilly France company unit, part of the Eli Lilly and Co drugmaker group, in Fegersheim near Strasbourg, France, February 1, 2018. REUTERS/Vincent Kessler

Teva Pharmaceutical Industries Ltd’s rival migraine headache preventer is excluded on one list and patients can pay more for it in some cases on a second list, the note said.

As with rival PBMs Express Scripts and CVS Health Corp, OptumRx’s lists of covered drugs, or formularies, cover tens of millions of consumers who receive their healthcare from employers and health insurers.

About 39 million Americans suffer from migraine headaches, according to the Migraine Research Foundation, and global migraine drug sales could reach $ 8.7 billion by 2026, according to analytics firm GlobalData.

OptumRx’s decision secures easier access to customers for Lilly’s Emgality at all three of the biggest PBMs – including CVS and Express Scripts – and gives Amgen’s Aimovig a leg up after CVS decided not to include it on its preferred drug list.

Teva’s Ajovy only has preferred status at CVS, while Amgen also has it at Express Scripts, part of Cigna Corp.

“We are pleased that all three companies have chosen Emgality to be one of the preferred medications, making it accessible to even more patients suffering from migraine,” Lilly said in an emailed statement.

Inclusion on a preferred drugs list by the largest PBMs and health insurers is critically important for sales of new medicines. Increasingly, PBMs are choosing a subset of treatments for their coverage list when there are multiple treatments that are considered equivalent.

The three treatments, approved by the U.S. Food and Drug Administration last year, belong to a class of drugs called CGRP inhibitors that have proven effective in helping to prevent migraines.

A Teva spokeswoman said the company is committed to increasing access to Ajovy regardless of formulary decisions and is still offering discounts that allow patients to pay nothing in some cases, regardless of insurance.

“Since Ajovy injection launched in September, we have experienced strong demand and steady growth, and we continue discussions with payers,” the spokeswoman said.

An Amgen spokeswoman said that the company was pleased with the decision and is committed to ensuring affordable access to its drug.

Amgen, which shares Aimovig U.S. revenue with Novartis AG, earlier this week reported fourth-quarter sales of $ 95 million, nearly doubling Wall Street estimates.

The OptumRx decision becomes effective Feb. 1.

The OptumRx select formulary relegates Teva’s drug to a lower access level that would typically require a higher out-of-pocket cost, it said.

PBMs typically extract discounts from drugmakers in return for favorable placement on their preferred list of covered drugs, such as through a low co-payment, or coinsurance payment, for their members.

All three migraine drugs have a list price of $ 575 a month, or $ 6,900 a year. Those prices do not reflect the rebates and discounts to PBMs, who design and negotiate benefits for employers and insurers.

All three drugmakers are providing a limited duration supply of the new drugs at no cost directly to patients in addition to other assistance programs.

Amgen’s Aimovig was first-to-market from the new class. But the rivals from Teva and Lilly followed soon after.

The three large PBMs together cover the majority of the more than 150 million Americans who receive benefits through their employers. Their clients, including insurers and corporations, may choose not to follow a PBM’s recommendations on coverage, but that typically would cost more.

Amgen shares were off 28 cents at $ 186.63, Lilly was up nearly 1 percent at $ 120.90 and Teva shares traded in New York were down nearly 1 percent at $ 19.69.

Reporting by Caroline Humer; Editing by Jeffrey Benkoe and Bill Berkrot

Reuters: Health News