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Preferring PCSK9s

How payers, PBMs are using ICER's analyses in PCSK9 coverage decisions

While the Institute for Clinical and Economic Review refines its value assessment of PCSK9 inhibitors, Express Scripts Holding Co. has already made its coverage decision for the new lipid lowering agents, and Prime Therapeutics LLC and Harvard Pilgrim Inc. have told BioCentury they plan to make coverage decisions for the mAbs in the next month.

On Oct. 6, Express Scripts announced it granted co-exclusive formulary status to Praluent alirocumab from Sanofi and Regeneron Pharmaceuticals Inc. and Repatha evolocumab from Amgen Inc.

Harvard Pilgrim is leaning toward an exclusive deal, and Prime is looking for an outcomes-based contract.

Express Scripts and Harvard Pilgrim have used the draft analyses from the Institute for Clinical and Economic Review (ICER) to inform negotiations with the companies, despite criticisms that have already led the non-profit to revise its estimate of a cost-effective price once.

FDA approved Praluent on July 24 and Repatha on Aug.

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