Express Scripts Covers Amgen and Lilly, but Snubs Teva's New Migraine Drug

White pills spilling out of a bottle in the shape of the word 'no'

With a new wave of migraine medications now on the market from multiple drugmakers that block the calcitonin gene-related peptide receptor (CGRP-R), Express Scripts has chosen to back two medications and exclude a third from the list of drugs it will carry.

This morning Reuters reported that Express Scripts, one of the largest prescription drug benefit managers in the United States, will cover the new anti-CGRP migraine drugs developed by Amgen and Eli Lilly, but will not carry one developed by Teva Pharmaceutical. The decision to exclude the Teva migraine drug was made following price negotiations between Express Scripts and all three companies, Reuters said. However, the report does not indicate exactly what differences the three companies had in their negotiations to cause Express Scripts to snub the Teva drug.

In May the U.S. Food and Drug Administration (FDA) approved Amgen’s preventative migraine treatment Aimovig. Amgen and its developmental partner Novartis worked quickly to have the medication available for prescribers. Aimovig, Amgen’s anti-CGRP migraine drug, was approved by the FDA after Phase III results showed the medication reduced monthly migraine attacks in half. Aimovig is self-administered once a month through Amgen’s SureClick autoinjector.

On Sept. 15, Teva’s Ajovy joined Aimovig as an approved anti-CGRP medication for the preventative treatment of migraines. Teva’s Ajovy was approved based on results from two Phase III clinical trials that showed patients receiving the treatment experienced a reduction of monthly-migraine headaches over a 12 week period. Ajovy was approved as the first anti-CGRP that could be injected monthly or even quarterly.

Near the end of September, Eli Lilly snagged regulatory approval for its anti-CGRP migraine medication Emgality (galcanezumab-gnlm). Lilly’s medication is injected monthly. During clinical trials, Emgality demonstrated a reduction in chronic migraine and episodic migraine.

Each of the three migraine treatments has the same list price -- $575 per month or about $6,900 per year. However, if a patient is able to benefit from Teva’s quarterly dosing, the price would be significantly less per year.

In its analysis, Reuters said Amgen’s Aimovig is a preferred migraine treatment. However, before a patient can be prescribed the drug, he or she must first try two older preventative treatments, according to the article. Express Scripts will cover Eli Lilly’s Emgality under the same terms, Reuters added. The prescription drug benefit manager anticipates that approximately 128,000 people who are Express Scripts customers will be good candidates for the migraine drugs.

In April 2019, both Amgen and Eli Lilly will begin to refund part of the cost of the drug is a patient stops treatment within 90 days, Reuters said. Such a move would indicate that the medication is not working to curb their migraine headaches or that the medication is causing an unwelcome side effect.

For Teva, the rejection by Express Scripts comes at a time the company is undergoing a corporate restructuring and, as Reuters noted, was hoping to capture a chunk of the migraine market. In December, Teva announced it was slashing approximately 14,000 jobs, about 25 percent of its global workforce. Alongside those job cuts, Teva said it was also closing a number of facilities as part of its restructuring.

Migraines impact about 12 percent of the population in the United States, including children. The pain and other symptoms associated with migraines can cause sufferers to completely stop what they are doing and prevent them from working or functioning in a normal capacity for more than a day.

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