Express Scripts drops Amgen anemia drugs from formulary

[August 02, 2014]  (Reuters) - Express Scripts Holding Co, the largest U.S. pharmacy benefit manager, on Friday said it will remove 25 products from its 2015 list of preferred drugs, including anemia treatments Epogen and Aranesp, both sold by Amgen Inc.

The company will continue to include Procrit, a similar anemia drug sold by Johnson & Johnson, on its list of preferred drugs, or formulary.

"The products we have chosen to exclude from our formulary are those that cost significantly more than other available options but that fail to provide additional health benefit," the company said in an emailed statement.

Express Scripts, which like other pharmacy benefit managers administers prescription drug benefits for employers and health plans and runs large mail-order pharmacies, said that patients who fill a prescription for an excluded drug will pay the full retail price.

Epogen, and second-generation drug Aranesp, have been hugely profitable for Amgen, although their use has waned in recent years due to safety concerns, including increased risk of heart problems. Still, the two drugs generated U.S. sales of $2.7 billion last year.
 

Officials at Amgen did not immediately respond to a request for comment.

The Thousand Oaks, California biotechnology company contracts directly to supply Epogen to kidney dialysis providers DaVita Healthcare Partners Inc and Fresenius Medical Care AG. Aranesp, like Procrit, is used to treat anemia in cancer patients and kidney disease patients who are not undergoing dialysis.

Express Scripts has been a vocal critic of rising prescription drug prices. For 2014, it excluded coverage of certain specialty drugs from five therapeutic categories, including multiple sclerosis and inflammatory diseases. It has also criticized the $84,000 cost of Sovaldi, the hepatitis C treatment introduced in December by Gilead Sciences Inc.

For 2015, Express Scripts also said it will no longer cover Incivek, an older hepatitis C drug sold by Vertex Pharmaceuticals Inc, and plans to make a determination on Sovaldi "once clinically equivalent competitors" are approved by regulators in coming months.

Other drugs excluded next year are a testosterone gel and extended release Zohydro, a long-acting opioid painkiller sold by Zogenix Inc.

"Of the more than 4,000 drugs available to patients, only 66 will be excluded from our 2015 formulary," the company said. It calculated that less than 0.2 percent of its members will be affected by the changes.

Express Scripts said it knows that there are rare instances when a specific patient has a unique circumstance in which they may require one of the excluded drugs, and it has a process for physicians to pursue in those cases.

The company, which has nearly 25 million Americans on its National Preferred Formulary, can drive enormous revenue toward drugmakers whose products it selects. They will typically be those that offer lower prices a for similar clinical benefit and for which patients will be charged lower co-pays.

(Reporting by Deena Beasley; Editing by Jonathan Oatis and Leslie Adler)

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