Physician Views: Will price reductions for the PCSK9s have a meaningful impact on utilisation?

Regeneron Pharmaceuticals and Sanofi have announced their first initiative to expand access to the PCSK9 inhibitor Praluent through lower pricing - but will it be enough? And what implications could it have for Esperion and their experimental cholesterol-lowering drug bempedoic acid?

In collaboration with Medefield MedePolls, we are snap-polling a sample of US cardiologists to gain a better understanding…

From a clinical perspective, what are you general opinion of the PSCK9 inhibitors - Praluent (alirocumab) and Repatha (evolocumab) - for the treatment of hyperlipidaemia?

Poor

Good

Excellent

Last week, Regeneron and Sanofi announced they will lower the net price of Praluent in exchange for straightforward, more affordable patient access from Express Scripts. Praluent will become the exclusive PCSK9 inhibitor therapy on the Express Scripts national formulary. The agreement "significantly simplifies the documentation necessary to secure insurance coverage and may help reduce out-of-pocket costs for eligible patients." Is the decision to lower the price of Praluent…?

Too little too late

A great initiative

Once the agreement takes effect with Express Scripts from July, physicians will submit a simplified attestation form confirming that Praluent is appropriate for the patient based on the FDA-approved indication and patient history. This is a significant simplification compared to many current utilisation management processes that involve multiple steps and lengthy documentation, including submitting laboratory results and detailed patient histories.

If this initiative is expanded (i.e. similar agreements are reached with other PBMs) do you think use of simplified attestation forms will meaningfully increase prescribing of Praluent to eligible patients?

No

Small increase

Large increase

Very large increase

Express Scripts estimates that through the arrangement, eligible patients will see their out-of-pocket-costs fall by around a third. Based on your experience - and again assuming similar initiatives are rolled out on a wider basis with other PBMs - would this size in reduction of costs meaningfully increase prescribing of Praluent to eligible patients?

No

Small increase

Large increase

Very large increase

Last week, Esperion released new data from a Phase III study showing that its experimental oral treatment bempedoic acid reduced LDL-cholesterol by 20% at 12 weeks and 24 weeks and 16% at 52 weeks versus placebo in patients receiving maximally tolerate statin therapy. LDL-C lowering for the bempedoic acid group at 12 weeks was 18 percent from baseline, compared to an LDL-C increase of 2 percent for the placebo group.

If approved, Esperion plans to price bempedoic acid at approximately $10 a day; to what extent do you think more competitive pricing of the PCSK9s will limit potential utilisation of bempedoic acid, based on its efficacy profile?

None

Small impact

Large impact

Very large impact

Results and related analysis will shortly be published for FirstWord Pharma PLUS subscribers to read, with the opportunity for non-FirstWord Pharma PLUS subscribers to purchase these findings. To be notified when poll results and analysis become available, please click here.

As always, FirstWord would very much like to receive your feedback and suggestions. Note: FirstWord Polls are powered by Medefield MedePolls, a fast-turnaround service to conduct instant polls of up to five questions with guaranteed samples that include physicians from dozens of specialties and over 100 markets. To conduct this poll with a different audience, or an entirely different poll, contact us at info@firstwordpharma.com.

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