Cigna agrees to value-based contracts to cover PCSK9 inhibitors

Cigna announced on May 11 that it had signed value-based contracts to cover evolocumab (Repatha) and alirocumab (Praluent).

The medications are proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors that the FDA approved last summer. At the time, the drugs were seen as potential blockbusters. They are used to lower low-density lipoprotein (LDL) cholesterol in certain patients who cannot control their LDL cholesterol with other treatments.

However, Sanofi reported sales of $10 million for alirocumab last quarter while Amgen, Inc. declined to disclose sales of evolocumab, according to an Associated Press article in April.

The annual wholesale acquisition costs of alirocumab and evolocumab are nearly $15,000, which is much more expensive than statins.

The deals with Cigna will reimburse Amgen as well as Sanofi and its co-marketer Regeneron Pharmaceuticals based on how well patients respond to the PCSK9 inhibitors.

Cigna said it was the first health insurance company to reach value-based agreements to cover both drugs for its commercial business.

“The contracts are independent of each other, but they share the same overall objective,” Cigna said in a news release. “If Cigna’s customers aren’t able to reduce their LDL-C levels at least as well as what was experienced in clinical trials, the two pharmaceutical companies will further discount the cost of the drugs. If the drugs meet or exceed expected LDL-C reduction, the original negotiated price remains in place.”

Cigna also said it planned on analyzing claims data to determine if patients taking the PCSK9 inhibitors have other cardiovascular improvements beyond reducing LDL cholesterol.

“Pharmaceutical advances hold great promise for improving the health of Cigna’s customers, and outcomes-based agreements help ensure that this promise is delivered,” Christopher Bradbury, senior vice president, integrated clinical and specialty drug solutions for Cigna Pharmacy Management, said in a news release. “Innovating through the contracting approach is one way we are helping our customers and clients receive more value for their health care dollar.”