Cost of Praluent for High Cholesterol Announced

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Those who suffer from high cholesterol may soon have a new treatment available to them - but at a very high cost to the Plan Sponsor. Praluent, a PCSK9 inhibitor developed by Sanofi and Regeneron Pharmaceuticals Inc., recently received FDA approval to be used for the purpose of lowering cholesterol and will be available through a limited number of specialty pharmacies. As reported by CBS News, it is "considered the first major advance in cholesterol treatment since statins were first introduced more than 20 years ago." However, though this may be a major breakthrough for certain patients who struggle with cholesterol on a daily basis, the benefits it can bring will come at a high price.

Designed to be injected into only a subset of patients who meet very specific criteria for this treatment, it was announced that Praluent will cost $40 for every day of treatment, which comes out to a whopping $14,600 per year. Unfortunately, this cost is higher than the already costly predictions - most were in the $10,000 range according to CBS. 

In addition to this new drug, also keep an eye out for another new PCSK9, which is due to be launched within the next 60 days and two other PCSK9s are expected to follow in 2016.

What this means for you...

For entities that provide pharmacy benefits to their employees or members, the introduction of this drug could certainly impact your plan and the price you pay for certain services if you provide pharmacy benefit coverage for individuals who require cholesterol lowering treatments. Of particular interest is the diversity amongst Pharmacy Benefit Managers pertaining to the clinical protocol for approval of PCSK9s along with some PBMs that are encouraging or mandating mail order only and/or offering a Per Member Per Month fee for PCSK9 Program clinical services. As a result of Pharmacy Benefit Manager increased costs for prior authorization, a Per Member Per Month Fee and the increased utilization of this high cost drug, Plan Sponsors will inevitably feel the effects of higher pharmacy benefit costs.

On another note, for covered individuals, this approval could also mean an increase in their cost share/copayment versus generic statins, another cholesterol treatment, which are known to only be about $100 per year.

As experts in the pharmaceutical industry, the team here at PBIRx is constantly working to find out how our current clients and future clients will be impacted by new drug approvals. Therefore, to learn more about how you may be affected when this new drug makes its way to the market, give us a call at (888) 797-2479 or visit us on our website to learn how our pharmacy benefit consulting and auditing services can help you in more ways than one.