You may have heard that Amgen, which manufactures the cholesterol-lowering drug evolocumab (Repatha), just announced it is lowering the list price of the drug by about 60 percent to $5,850 per year from its original list price of $14,523.
The company says that the goal of the price drop is to help lower patients’ copays, especially for people on Medicare.
At first, it seems like great news for patients when a drug company announces a huge price decrease like this, but because of the complicated nature of our health care system, it doesn’t necessarily mean that patients like you will start saving money.
Here’s what you need to know about how this news may — or may not — affect you.
What Is Repatha?
Repatha is in a drug class known as PCSK9 inhibitors, which are injectible biologic medications that can dramatically lower LDL cholesterol levels in people with genetically high cholesterol (a condition known as familial hypercholesterolemia) or in those at high risk for heart attack or stroke. These drugs stop the body from making a protein called PCSK9 that is involved in cholesterol production.
Large-scale clinical trials have shown that these drugs reduce the risk of heart attack, stroke, and death. They can be lifesaving in people who can’t tolerate statins, the most commonly prescribed cholesterol-lowering drugs, or when statins don’t work well enough to lower cholesterol.
Why Did Amgen Lower the Price of Repatha?
When PCSK9 inhibitors were approved in 2015, they were expected to be blockbuster drugs that could generate billions of dollars a year in sales. In reality, sales have been much softer. Last year, global sales of Repatha were $319 million and sales of Praluent (another PCSK9 inhibitor that is sold by Sanofi/Regeneron) were $195 million, which was far below expectations, according to Forbes.
A main reason is because of access issues. Many people who are prescribed these drugs by their doctors have struggled to get insurance reimbursement. Generic statins cost pennies a day, so insurers have restricted how many people can take PCSK9 inhibitors.
In fact, about three-quarters of patients who are prescribed Repatha never actually fill the prescription, mainly because of high out-of-pocket costs, Robert Bradway, chairman and chief executive officer at Amgen, said on a conference call about the list price change.
This is why Amgen reduced the price, but in order for you to benefit, your insurance company will need to pass these savings on to you. That may not happen unless you speak up.
Understanding the Price Change on Medicare vs. Private Insurance
Once patients on private health insurance plans get through their insurance company’s arduous prior authorization process, they have been able to use rebates and other forms of financial assistance from the drug maker to help lower out-of-pocket costs for Repatha, but these reimbursement practices are illegal in Medicare.
PCSK9 inhibitor manufacturers utilized different deals with private payers that discounted the original list price of $14,523 in exchange for what little formulary access or exclusivity they got, according to MedPage Today. That, plus copay cards, made the drugs more affordable for many patients, but it couldn’t alleviate the copay problem for people on Medicare Part D.
Patients on Medicare Part D have to pay between 20 and 33 percent of the price of their drugs, which is calculated based on the list price.
Amgen decided that lowering the list price of Repatha was the best way to help make the drug more affordable to people with Medicare.
Repatha copays have been in the range of $280 to $370 per month for Medicare Part D patients but should drop to $25 to $150 per month after the list price change, MedPage Today reported.
We think Repatha should neatly fit into what is known as Tier 3 in the Medicare drug world, which means your copay maximum will be $47. It could be as low as $25.
So, Will Repatha Cost Me Less Money?
If you are on Medicare, yes. If you have private insurance, not necessarily.
The retail, or list, price of drugs is often irrelevant to patients because patients don’t pay retail prices. Patients pay a copay, a deductible, and a premium to their health insurer.
When a company like Amgen announces a drop in a drug’s list price, that saving doesn’t automatically get passed on to patients with commercial insurance unless insurers decide to do so.
It is reasonable to expect the Medicare Part D copay for this class of drugs to drop to $25 to $47 a month with this retail price reduction because it will fall into Medicare’s Tier 3 drug class.
But with commercial insurers, it’s not this easy. You’ll have to call them or talk to your employer if that’s where you get your insurance.
How Can I Start Paying Less for Repatha?
First, know that any changes in Medicare Part D drug pricing will likely happen slowly. You may not see this until 2019. It’s possible that changes won’t take effect until 2020, but Amgen has said it wants these price reductions to take effect immediately. We’ll have to wait and see what happens.
Why the possible delay? Amgen said that some prescription plans may opt not to change their pricing on Repatha until current contracts with Amgen end, so some patients won’t see price cuts right away, the Associated Press reported.
Medicare Part D plans are designed for the following year in the spring of the year before (so 2019 plans were designed in the spring of 2018). This means that the new announcement may not apply to plans until 2020, though Amgen said that off-cycle changes to insurance plans are possible.
If you are not on Medicare, contact your state insurance commissioner and let them know that you heard about the news of the list price decrease for Repatha, Amgen’s PCSK9 inhibitor, and you want to make sure the savings will be reflected in your insurance plan. Here is a national map that has links and contact information for each state’s insurance commissioner.
It is important to speak out and let your insurance company know that you want these price decreases passed along directly to you, in the form of cheaper copays for these drugs, and the sooner the better.
What This News Means for All Chronic Disease Patients
Even if you don’t need to take a PCSK9 inhibitor to lower high cholesterol, the issue of savings from decreases in drug list prices not being passed on to patients is concerning to everyone living with chronic illness. We’ve seen similar situations where insurers keep the profits from drug price reductions with other costly or innovative drug classes, and we will undoubtedly see it again in the future.
Make a Difference and Join the 50-State Network
If you want to follow this issue and get involved as a patient advocate to speak out against issues that affect patients’ access to affordable medications, you can sign up for our 50-State Network. This is a national grassroots group of patients who receive ongoing training to self-advocate on policies that affect their health care, as well as opportunities to speak with legislators and other stakeholders. Learn more and sign up here.