Regeneron Pharmaceuticals and partner Sanofi are cutting the list price of their heart drug alirocumab (Praluent) by 60 percent, the latest acknowledgement that the treatment—which has shown a striking ability to lower cholesterol, but has struggled to sell because of its high price tag—isn’t getting to the patients who need it.
Starting in early March, Regeneron (NASDAQ: [[ticker:REGN]]) and Sanofi (NYSE: [[ticker:SNY]]) will slash alirocumab’s per year list price from roughly $14,000 to $5,850. The move mirrors an October announcement from Amgen (NASDAQ: [[ticker:AMGN]]), which also cut the list price of its similar, rival drug evolocumab (Repatha) to $5,850.
The price cut is largely meant to lower out-of-pocket costs for patients on Medicare, the government funded healthcare program for the elderly. It isn’t expected to lead to significant changes for patients on commercial insurance, according to a Regeneron spokesperson. And it also won’t change the “net” price—the figure paid after discounts to insurers and drug-pricing middlemen—of alirocumab, the spokesperson says.
The move is the latest evidence of the commercial trouble cholesterol-lowering drugs known as PCSK9 inhibitors have had since the FDA approved them in 2015. Alirocumab and evolocumab were hailed as big medical advances for their striking ability to clear LDL-C, or “bad” cholesterol,” from the bloodstream. But the two drugs have had disappointing sales because payers balked at their high prices, waiting for evidence that the drugs didn’t just lower cholesterol, but also lowered the risk of heart attacks, strokes. Both companies have produced such evidence over the past two years, and they’ve also since tried various strategies—and now pay cuts—to try to boost their sales.
When Amgen, for instance, announced in 2017 that evolocumab succeeded in a 27,000 patient study called Fourier, it said it would give refunds to payers that “lower access barriers” if patients taking the drug suffer a heart attack or stroke. The following year, Regeneron posted results from a similar study, Odyssey Outcomes, and went a step further: It agreed to lower the “net” yearly price of alirocumab, after discounts to payers, to a range ($4,500 to $8,000) set by the Institute for Clinical and Economic Review, a nonprofit drug-pricing watchdog. That move got alirocumab on the formulary, the list of covered drugs, of drug-buying middleman Express Scripts (NYSE: [[ticker:ESRX]]). Regeneron didn’t change the drug’s list price, however.
Those strategies have helped boost sales somewhat—last week, Regeneron reported $307 million in 2018 alirocumab sales, compared to $195 million in 2017—but both companies have since acknowledged that they didn’t move the needle far enough. As Regeneron CEO Leonard Schleifer says in a statement this morning, seniors are “often still unable to afford [alirocumab] due to high co-pays or co-insurance” with many Medicare Part D plans. Amgen had similar sentiments, too, in October, when it slashed evolocumab’s list price. The two are hoping that their respective list price cuts will reduce monthly out-of-pocket costs for Medicare patients from as much as $370 apiece to $25-$150 apiece, and boost access to their drugs.
A Regeneron spokesperson says that the company will be reaching out payers to discuss the impact the new price cut will have on its current agreements. “We hope that payers will do their part to help ensure savings are directly passed on to more patients, through lower out-of-pocket costs,” Michelle Carnahan, the head of Sanofi’s Primary Care Business Unit in North America, said in a statement.
Here’s more on alirocumab, evolocumab, and the commercial struggles they’ve had.
