This Is How You Do Value-Based Care

May 1, 2018
Working with Regeneron and Sanofi, Express Scripts will be the first to directly deliver drug-specific savings to patients, making PCSK9 therapy more affordable and more accessible.
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  • High Blood Cholesterol
RPh Computer Article

Today we announced a new agreement with Regeneron Pharmaceuticals and Sanofi, makers of the PCSK9 inhibitor Praluent® (alirocumab) Injection, that will greatly improve the affordability and accessibility of this medication for patients whose plans are enrolled in our Cholesterol Care Value Program, part of our SafeGuardRxSM suite of solutions

In the rhetoric around drug pricing, there has been much discussion about value-based care and how to make it happen. Today’s announcement demonstrates that when you have drug makers and payers willing to work together to responsibly price a medication based on clinical and economic evidence, the result is true value-based care that leads to greater affordability, accessibility and outcomes for patients.

Streamlined Approvals, Shared Rebates

Beginning July 1, 2018, Praluent will be the exclusive PCSK9 inhibitor for plans enrolled in our Cholesterol Care Value program. We’re also significantly simplifying the documentation necessary to secure insurance coverage, asking physicians to submit a simple attestation form confirming that Praluent is appropriate for the patient based on the U.S. FDA-approved indication and patient history. The approval process is even further simplified using the electronic prescribing and prior authorization tools we’ve been investing in over the past 4 years to reduce administrative burden on prescribers and their staff.

Additionally, Express Scripts will pass a portion of the Praluent rebates it receives from Regeneron and Sanofi to patients whose pharmacy plan is enrolled in the Cholesterol Care Value Program and who fill their Praluent prescription medication at our Accredo Specialty Pharmacy. As a result, these patients soon will see lowered out-of-pocket costs when they fill their medication.

Praluent also will be the exclusive PCSK9 inhibitor on our National Preferred Formulary beginning July 1, 2018.

Specialized Care

Our specialized care team at Accredo pairs patients with expert specialist pharmacists who have deep understanding of cardiovascular disease and familial hypercholesterolemia. Our holistic approach to care ensures patients get the full benefit of innovative medicines like Praluent, and helps them overcome the barriers to adherence with an injectable medication and an asymptomatic condition. In 2017, 14% more patients achieved optimal adherence to PCSK9 therapies when receiving specialized care from Accredo vs a retail pharmacy setting.

First of its Kind

When PCSK9 therapies first came to market, little was known about the long-term effect of lowering LDL in this manner. For both patient safety and payer affordability, it was important for Express Scripts to help payers ensure therapy with his class of drugs was appropriately managed.

Earlier this year, Regeneron and Sanofi presented new clinical research that gave us more information about the longer-term use of these medications and highlighted a significant reduction in the risk of death (29%) for high-risk patients who have had a heart attack or other serious coronary event, and whose cholesterol levels exceed the threshold recommended by doctors despite taking statins. Working off of a recommendation from ICER, they agreed to lower the net price of Praluent for payers who were willing to reduce access barriers for appropriate patients. We’re proud to be the first to make this agreement a reality for our clients and members.

As I have said before, innovative therapies require payment models that are equally innovative. Working with willing participants in the pharmacy supply chain, we are making value-based care a reality for our clients and members, and ultimately putting medicine within their reach.

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