AbbVie’s deal with the PBM Express Scripts has altered the dynamic in hepatitis C price-setting, writes Bloomberg.
Several payers have been vocal about not wanting to cover the $1,000-a-pill price for Gilead’s hepatitis C drug Sovaldi. But due to the pill’s big leap in efficacy, they have for the most part been compelled to put it on formulary.
AbbVie’s deal with the big PBM Express Scripts to lock out Gilead’s Sovaldi and all-oral sibling Harvoni from use among GT-1 hep. C patients on its national formulary “flips the balance of power to favor insurers and pharmacy benefit managers,” who can play drugmakers against one another to extract price concessions on HCV meds, notes Bloomberg.
It means the biotech’s HCV portfolio may not remain insulated from payer management for long. The first PBM to force Gilead to the bargaining table? One analyst tells the news service Gilead “would be most motivated to cut a deal with CVS,” which accounted for about 26% of the US pharmacy benefits market last year (Express Scripts, which is number one, manages benefits for 85 million people).
The AbbVie deal “puts a lot more pressure on CVS and Gilead” to pursue a deal, agrees another analyst.
Neither Gilead nor CVS would comment on the speculation. Meanwhile, other PBMs with sizable HCV populations are in watch-and-wait mode, too, Bloomberg reports.