Large PBM covers 2 migraine treatments, excludes another

January 29, 2019

CVS Health adds new migraine drugs to its list of covered drugs, but excludes one rival treatment.

CVS Health’s addition of 2 new migraine prevention drugs to its list of covered drugs should greatly benefit the 2 pharma makers, but could impact sales of a third migraine treatment.

While the PBM added galcanezumab-gnlm (Emgality, Eli Lilly and Company) and fremanezumab-vfrm (Ajovy, Teva) injection to its list of covered drugs, it excluded erenumab-aooe (Aimovig, Amgen and Novartis), Reutersreported.

“At CVS Health, we work to ensure that patients have access to the most clinically appropriate medications and that payers have the right cost management tools in place to help manage overall healthcare spending. We currently have 2 CGRP inhibitors, Ajovy and Emgality, on our commercial formulary, which are available to members who have tried other preventive migraine treatments without success,” Christine Cramer, a spokesperson for CVS Health, told FormularyWatch.

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The prices on the Ajovy and Emgality are deemed cost effective by the Institute for Clinical and Economic Review (ICER), Cramer told Reuters.

All 3 treatments have a wholesale acquisition cost of $575 a month, or $6,900 a year, before discounts and rebates.

Cramer declined to elaborate about why Aimovig is not included on the coverage list.

However, Aimovig is expected to snare 38% of the migraine prevention market with a projected $917 million in US sales, according to Leerink estimates and the pharma makers, John Santilli, president of Market Access Intelligence, told FormularyWatch.

CVS’s decision to cover Ajovy and Emgality “provide a boost for both drugs in the market,” Santilli said. Emgality is expected to earn $296 million in the US by 2020, and Ajovy is expected to make $228 million.

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“Lilly is optimistic as they look to continued growth in the migraine marketplace. Lilly believes it is well positioned in the migraine market-of both preventative and acute,” Santilli said.

Around 60% of commercial patients now have access to Ajovy through covered drug lists and that discussions are continuing with other national and regional payers, a Teva spokesperson told Reuters.

While CVS’s exclusion of Aimovig is not great news for Amgen and Novartis, the impact “may not be all that bad as the drug does enjoy preferred status elsewhere, such as Cigna-Express Scripts,” Santilli said. Plus, the treatment is already used by 150,000 patients and more than 18,000 physicians prescribe Aimovig, he added.

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