Two newly drugs that can sharply lower cholesterol are extremely costly. Repatha from Amgen and Praluent from Sanofi and Regeneron Pharmaceuticals can lower cholesterol levels by 4-% or more. But at $14,100 a year for Repatha and $14,600 a year for Praluent, they may break the bank for several health insurers, especially since they will have to be used for life.
But now Institute for Clinical and Economic Review (ICER), a nonprofit organization, has issued a draft report saying that both drugs are vastly overpriced based on the value they provide. Their prices should be about one-third as much as that set by their manufacturers and even at that then the two drugs could strain healthcare budget. To avoid that, the cost should be about 15% of what it is now. Both drugs are injectables that are used once or twice a month.
This report could put more pressure on the makers of the cholesterol drugs to offer bigger discounts. Express Scripts, the country's largest pharmaceutical benefit manager, has said it plans to use the report's findings in its negotiations with the drug companies.
"Even if these drugs were used in just over 25% of eligible patients, then employers, insurers and patients would need to spend on average more than $20 billion a year," Dr. Steven D. Pearson, the president of ICER, said in a statement.
The report said Repatha and Praluent should cost $3,615 to $4,811 a year, based on the value they are expected to provide in preventing heart attacks and deaths. They should cost $2,177 per year to be at a level where health plans would not have to limit their use to prevent straining health care budgets.
ICER's report is expected to be the first of many price analyses that will evaluate the cost-effectiveness of these drugs. Health care economists use different thresholds for determining when a procedure or drug is cost-effective. Different analyses may reach different conclusions because they depend on several assumptions and different groups may use different assumptions.
Amgen said in a statement that it disagreed with ICER's methodology, assumptions, and preliminary conclusions, which it noted had not undergone public comment or formal peer review because it is at the draft stage.
Regeneron said it had not had adequate time to review ICER's report. But a spokeswoman for the company said, "These calculations are complex, and a robust and open peer-review process is essential."
