This isn’t the first time the Repatha price has dropped 60%

CRASH COURSE

Earlier this week, Amgen launched their direct-to-patient platform (AmgenNow) and announced that Repatha^® (evolocumab) will be the first drug available through this platform. Repatha is a PCSK9 inhibitor that was first approved in 2015 for high cholesterol. It is now available for $239 per month through AmgenNow, which is around 60% lower than its current US list price.  

This isn’t the first time the price of Repatha has dropped by 60%. This press release titled “Amgen Makes Repatha^® (Evolocumab) Available In The US At A 60 Percent Reduced List Price” is from seven years ago.

When Repatha was first launched in 2015, it was priced at a list price around $14,000 per year. Uptake was slower than expectations—partially due to payer utilization management, pricing, and patient out-of-pocket costs.

In 2018, Amgen announced that it would cut the list price by 60% which reduced the list price to $5,850 per year. This lower list price for Repatha was “around its old net price”, suggesting that large rebates on the list price were already being offered before this announcement, but “higher rebates don’t typically result in lower out-of-pocket costs for patients”. Thus, this reduction in list price was intended to “improve affordability by lowering patient copays”.

Besides patient affordability concerns, a Fierce Pharma article explained “another good reason for the permanent price-slashing on Repatha:  competition”. Repatha wasn’t the only PCSK9 inhibitor on the market. A month before Repatha received FDA approval, Sanofi and Regeneron received FDA approval for their PCSK9 inhibitor, Praluent^®. It was also initially priced at a list price of around $14,000 per year. Uptake was also slower than expectations.  

In 2018, Sanofi and Regeneron pitched “a lower price to payers in exchange for better—read less hassle-ridden—coverage”. They made a deal “to win an exclusive spot on Express Scripts’ national preferred formulary” in exchange for a net price between $4,500 and $8,000 per year supported by its cost-effectiveness.

Then, in 2019 (a few months after Amgen cut the list price of its PCSK9 inhibitor to $5,850 per year), Regeneron and Sanofi cut its list price by 60% to $5,850 per year. Over time, competition has continued to enter the market. An October 2019 article about the price war between the two approved PCSK9 inhibitors also discussed inclisiran which was in phase 3 clinical trials at the time of the article and later received FDA approval in 2021.

SO WHAT

A drug’s price changes over time due to a variety of market dynamics. In a new opinion piece I wrote in BioSpace, I discuss how the “initial list price is only one frame in the longer story of a drug’s lifecycle”.

As we saw with Repatha, the initial list price of $14,000 per year was not reflective of its price over its entire time in the market. Repatha is still under patent protection, but we have already observed how the market is working to lower its price. Even before the launch of the direct-to-patient platform (and even before biosimilars have entered), payer restrictions and within-class competition lowered the price of Repatha over time.

A drug’s price might seem high when it is first launched, but the market-based approach to drug pricing in the United States is set up so that the price should go down over time. In a span of ten years, Repatha went from $14,000 per year (based on its list price) to $3,000 per year (through AmgenNow).

Patent protection might make it seem like the manufacturer can set the price as high as it wants, but payer restrictions and competitor drugs show that is not the case. Insurance companies and their affiliates have mechanisms to negotiate through their ability to not cover some medicines, to implement utilization management, or to give preferential placement to competitors. Even with patents and market exclusivity, there are still market forces.

Especially with multiple treatment options available, payers can leverage each treatment against each other to secure a lower price. Repatha and Praluent have been in a “pricing war” for a decade—and they are both still covered by patents.

As a nerdy pharmacoeconomist, I will always be interested in studying if there can be an optimal price that is dynamically efficient and provides the incentives to produce the optimal rate of innovation. But I will also continue to appreciate the real-world market dynamics at work that lower prices over time.