For years, the drug maker Amgen has struggled to sell its new anti-cholesterol drug, Repatha after insurers balked over the list price of about $14,000 a year.
On Wednesday, Amgen took a new approach: It said it would slash the list price to $5,850 a year in hopes of increasing sales, especially among Medicare beneficiaries who are particularly vulnerable to a drug’s list price.
Amgen announced the move at a time when the drug industry, under public pressure to do something about high costs, is struggling to demonstrate that it is addressing the issue. The Trump administration has made the cost of drugs a major piece of its health care agenda, with Alex M. Azar II, the secretary of the Department of Health and Human Services, frequently focusing on the list prices.
But few consumers pay the list price. In recent months, several major manufacturers have bowed to government pressure, putting temporary halts on planned price increases, although few have lowered list prices. The drug makers have said that’s because they are beholden to intermediaries, like the pharmacy benefit managers and distributors, who take a percentage of their pay from a drug’s list price, creating an industrywide incentive to keep list prices high.
One exception was Merck, which in July announced it was rolling back the list prices of several of its minor products, including a 60 percent cut of the list price of its ailing hepatitis C drug, Zepatier.
It’s unclear whether Amgen’s decision to discount Repatha’s price signals an industry shift, or whether it is an isolated move by a company to rescue what had once been touted as a potential blockbuster.
Amgen’s top-selling drug is the arthritis treatment Enbrel, which brought in $5.4 billion in 2017, and which has come under scrutiny for its rising price. Repatha, by comparison, generated worldwide sales of $319 million last year, according to Amgen.
Repatha is one of two so-called PCSK9 inhibitors — Praluent, sold by Regeneron and Sanofi, is the other — that arrived on the market in 2015 with great fanfare because they were able to lower people’s cholesterol to previously unheard-of levels. Although subsequent studies have shown that they do prevent heart attacks, the benefit wasn’t as great as initially hoped.
Insurers have been reluctant to broadly cover the drugs, instead requiring patients and their doctors to demonstrate why the patients could not instead take the cheaper alternative — statins. The drug companies have fought back, enlisting the help of patient advocacy groups that receive donations from the manufacturers to make the point that the insurers’ restrictions are unfair.
Last May, Regeneron and Sanofi, which jointly sell Praluent, slashed the net price — or what they charge insurers and employers — in a similar effort to revive sales, and Amgen has also been offering deeper discounts in exchange for promises from insurers that they will remove some of the barriers to consumer access.
But Amgen executives said yesterday that those behind-the-scenes discounts didn’t help many patients, especially Medicare beneficiaries who frequently must pay a percentage of a drug’s list price out of their own wallets.
Amgen estimated that 75 percent of Medicare patients who are prescribed a PCSK9 inhibitor never fill their prescriptions, mainly because of the cost. Medicare beneficiaries, who account for about 40 percent of Repatha prescriptions, are barred from using company coupons because federal anti-kickback laws prohibit their use in government health care programs.
“Concerns over out-of-pocket costs have proven to be a barrier to its use for too many patients,” Robert A. Bradway, the chairman and chief executive at Amgen, said in a statement. “We want to make sure that every patient who needs Repatha gets Repatha.”
Its new list price is roughly equal to the amount Amgen was pocketing after giving discounts to insurers and employers. Patients with private insurance might have to pay the list price during their plans’ deductible phase — or might have to contribute a percentage of the list price. Or they might still have to pay the higher amount until their insurer’s contract with Amgen expires, the company said.
Until 2020, it will continue to offer Repatha under the higher list price to insurers who decide they prefer the older system of rebates, where manufacturers pay them after-the-fact discounts on the list price.
