Under pressure to forge a deal of its own after an Express Scripts decision favoring AbbVie’s hep.-C drug, Gilead reached an agreement with CVS/Caremark for exclusive formulary status for its Harvoni and Sovaldi drugs. The PBM said it will cover the two drugs as exclusive options on its formularies and exclude AbbVie’s product, Viekira Pak.
The deal comes two weeks after Express Scripts’ decision making the AbbVie drug regimen the exclusive choice for treating HCV genotype-1 patients among the 25 million members on its national formulary, which other customers of the PBM may follow. The PBM’s blow against high drug prices came with an unknown price discount from AbbVie that the benefits manager said will make the drug more affordable and enable HCPs to treat patients at all stages of the liver-wasting disease.
In Gilead’s case, a CVS spokesperson declined to confirm payment of a discount for its preferential formulary treatment, which is being made available for treating patients with all HCV genotypes, in response to a reporter’s questions.
Nor did the spokesperson explain how CVS’s formulary will handle patients at different stages of the disease. By contrast, Express Scripts is making Viekira Pak available to all GT-1 HCV patients, regardless of disease stage.
“Our goal was to create the lowest net-cost solution for the entire population of patients with all genotypes of Hepatitis C,” said Christine Cramer, director public relations, CVS/Caremark PBM services, which is a unit of CVS Health.
As Express Scripts covers 30% to 33% of the US PBM market, its deal with AbbVie excludes Gilead from roughly a third of PBM-covered patients, while CVS’s deal now potentially blocks AbbVie’s drug from the 27% to 30% of the market it controls, Bloomberg reports, quoting a Deutsche Bank analyst.
CVS/Caremark said the Gilead drugs will have preferred status on its Standard Commercial formulary, Medicare Part D, and Medicaid formularies, and the formulary for exchanges set up under the Affordable Care Act. The policy goes into effect tomorrow, January 7.
About 25 million lives on CVS’s standard formulary are directly affected by the formulary change, about the same number covered by Express Scripts’ national preferred formulary, analyst Mark Schoenebaum pointed out in an investor note Tuesday.
While Gilead is rallying from Express Scripts’ ground-breaking deal with AbbVie, more benefit managers are expected to level attention on the hep.-C category, as the drugs’ high cure rates drive soaring sales, straining payer budgets.
Sales of the one-pill treatment Harvoni since its October launch have been outpacing Sovaldi, which posted $8.5 billion in sales in the first three quarters of 2014. A CVS Health analysis in December found Harvoni prescribing rates 2.5 times as rapid after launch compared to Sovaldi, with Harvoni use surpassing Sovaldi use overall in CVS/Caremark managed plans.
IMS Institute’s 2014 Global Outlook for medicines report projects the viral hepatitis drugs will lead all pharma categories in annualized growth rates, growing at an annual rate of between 36% and 39%, and reaching $22 billion in sales by 2018 in developed markets and $4 billion in sales in emerging markets thanks to an annual growth clip ranging between 20% to 23%.