Thursday, October 15, 2015

Express Scripts Will Cover the Newest (Expensive) Cholesterol-Lowering Drugs

 I posted a blog recently about the two newest cholesterol-lowering drugs, made by Amgen and Sanofi SA (See this blog, Oct. 6, 2015). The new drugs will be very expensive; approximately $14,000 per year, compared to just a few dollars a month for the statins. I raised the question about whether insurers should cover the new drugs just because patients say they want them.

When the prices of the new drugs were announced, it seemed that the intent was to limit the use of the drugs to those patients who couldn't achieve adequate cholesterol reduction with the statins. According to FoxNews, insurers planned to "aggressively challenge" claims of statin intolerance before agreeing to pay for them. But how will insurers respond when physicians write prescriptions for the new drugs for their patients? I'm betting that patients will demand the new drugs once the drug companies start their ad campaigns, and that insurers will be pressured into paying the exorbitant bill.

At least one pharmacy benefits management company, Express Scripts, has included the new drugs in its 2016 list of approved drugs, but the company added that there would be "restrictions" on who could use them. Good luck with that! It will be interesting to see whether they actually do manage to restrict their use, or whether the costs to insurers will spiral out of control.

If you think it doesn't matter, consider this; high health insurance expenses by other insured individuals ultimately affects your insurance rates.

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