The nation’s largest pharmacy benefits manager is throwing its weight into a fight over the high cost of treating hepatitis C, saying it will cover a new drug from AbbVie while pulling back on more expensive options from rival drugmakers.
Express Scripts Holding Co. said Monday it will no longer cover Sovaldi and Harvoni from Gilead Sciences Inc. or Johnson &Johnson’s Olysio starting Jan. 1, except under limited circumstances. AbbVie Inc.’s Viekira Pak, approved only Friday, will become the preferred treatment for patients who have genotype 1 hepatitis C, the most common form of the liver-destroying virus.
Express Scripts will still cover the other drugs if patients have already started treatment or if the patient has a clinical exception and needs those particular drugs.
It also will still cover Sovaldi and Olysio for patients with other genotypes of hepatitis C and advanced liver disease.
The three drugs that will no longer be covered are part of a wave of effective but expensive treatments that hit the market in the past year. Patients and insurers have been hoping that growing competition will help reduce prices or give payers like Express Scripts some leverage to negotiate better rates.
Express Scripts Chief Medical Officer Dr. Steve Miller said that leverage can only be used if competing drugs are considered at least clinically equivalent, meaning they are as good or better than the more expensive treatments. Express Scripts said a committee of independent experts has verified this for the pharmacy benefits manager.
Express Scripts manages prescription drug benefits for about 85 million people, and this decision affects about 25 million of its commercial customers. But that total could grow.
Miller said other customers have expressed interest in this approach.
Pharmacy benefits managers, or PBMs, run prescription drug plans for employers, insurers and other customers. They process mail-order prescriptions and handle bills for prescriptions filled at retail pharmacies.
Sovaldi, which was approved late last year, costs $84,000 for a course of treatment.
That price can rise up to $160,000 when Olysio is paired with it, Dr. Miller said.
Harvoni was approved in October, and Gilead has said the new drug will cost $94,500 for a 12-week supply.
Gilead executives have said their drugs are cost effective, despite their large upfront cost, because they cure more patients in less time than older drugs, and prevent the catastrophic problems for patients like liver failure.
Representatives of Gilead and Johnson &Johnson did not immediately return calls from The Associated Press seeking comment Monday morning.
AbbVie has said the shortest approved course of therapy for Viekira, 12 weeks, will cost about $83,320 at wholesale prices.
An Express Scripts spokesman said his company received a “significant discount” for its coverage of Viekira Pak off of that price, but he declined to offer details.
Shares of Gilead sank nearly 11 percent, or $11.67, to $96.78 Monday morning, and AbbVie also slipped 75 cents to $66.96 while broader indexes rose slightly.
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