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AbbVie's Humira Numbers Show How Well The Company Can Play the Rebate Game
And a brief history of Lilly's copay coupon for Mounjaro
Brian Reid
July 28, 2023
The Humira biosimilars market continues to be the most stimulating part of the industry. How the rebating will work and how list prices and net prices will impact volume remain critical, unanswered questions.
But we got a little more insight into the market yesterday, with AbbVie reporting better-than-expected Humira numbers. The strategy -- as outlined by the Wall Street Jourmal -- is that AbbVie seems to be maintaining scrip volume by strategic net price reductions.
Of course, the numbers cover the second quarter, when there was only one competitor (Amgen’s Amjevita). Things may change with the July 1 introduction of a whole passel of other biosims, and the market will shift again as contracts are renegotiated.
Or maybe not, or maybe not soon.
AbbVie is projecting some confidence going into next year, telling analysts: “if you look to '24 … we do have 2-year agreements with some of our accounts. And we negotiated those in good faith, and we expect them to be honored.”
The fact that AbbVie has been able to play the game better than analysts have expected is certainly worthy of note.
There’s been a lot written about the GLP-1 based medicines for diabetes and weight loss, but one element that hasn’t seen a deep look is the way that coupon programs play into the fundamental economics of the therapeutic area.
But it’s not a minor question. Discussions of copay cards is a regular feature of the Lilly earnings calls (the next one happens in a couple of weeks), so I thought it would be interesting to see the evolution of one part of Lilly’s program: the assistance available to Mounjaro patients who have insurance, but where Mounjaro is not covered.
Here is the policy as of a year ago:
For patients with commercial drug insurance who do not have coverage for Mounjaro through their commercial drug insurance: Offer good until 06/30/2023 for up to 12 fills or whichever comes first. Patients must have commercial drug insurance and not have coverage for Mounjaro to pay as little as $25 for 4 pens of Mounjaro. Offer subject to a monthly and annual cap of wholesale acquisition cost plus usual and customary pharmacy charges.
Patients who snagged that card last year could still use the program through last month. But for those who missed that coupon, Lilly revised the program earlier this year:
For patients with commercial drug insurance who do not have coverage for Mounjaro through their commercial drug insurance: Offer good until 06/30/2023 for up to 7 fills or whichever comes first. Patients must have commercial drug insurance without Mounjaro coverage and a prescription consistent with FDA-approved product labeling to obtain savings of up to $500 off your monthly fill for 4 pens of Mounjaro. Offer subject to a monthly cap of up to $500 and a separate annual cap of up to $3,000.
That was revised again, and the current program is a little more generous if a little more detailed:
For patients with commercial drug insurance who do not have coverage for Mounjaro: You must have commercial drug insurance that does not cover Mounjaro and a prescription consistent with FDA-approved product labeling to obtain savings of up to $575 off your 1-month prescription fill of Mounjaro. Month is defined as 28-days and up to 4 pens. Card savings are subject to a maximum monthly savings of up to $575 and a separate maximum annual savings of up to $3,450 per calendar year. Subject to Lilly’s right to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason, Card expires and savings end on 12/31/2023.
The reality is that there is -- and will continue to be -- a huge market of patients for whom the GLP-1 drugs are uncovered, so the evolution of economics of how those meds make their way to patients will be fascinating.
GSK put a list price on its RSV preventative treatment, Arexvy: $280 a shot. That’s at the high end of what’s been expected, driven in part by strong durability data. It’s also higher than the range that Pfizer has suggested for its competitive product.
PhRMA is asking the courts to overturn a new Louisiana law that restricts the ability of drugmakers to push back against the use of contract pharmacies in 340B. It looks like a replay of the ongoing dispute over a similar law in Arkansas.
This JAMA “Perspective” is, on its surface, about out-of-pocket caps on specific medicines (such as insulin) and the unintended consequences of such efforts. But it’s actually a Trojan horse to a much more radical proposition: tiptoeing toward an insurance system in which premium and cost-sharing are income-based.
The dialogue around the IRA lawsuits has really evolved. The initial reaction from hte legal community was a pretty hard eye-roll. But the coverage seems to tilting toward the idea that maybe, just maybe, these suits will work. The latest evidence is this Barron’s piece that quotes an analyst who puts 60% odds on part of the law being thrown out.
Axios goes deep on efforts in Washington to try to fix prior authorization. It’s possible that physicians hate insurers even more than pharma does, and prior auths are probably the single biggest reason why.
The topic of risk pools for gene therapies is high on the boring-but-important list. There’s not much to be snarky about here, but Bloomberg Law has a brief piece about how employers are starting to explore risk polls as a way to make gene therapy coverage more viable.
I’m not sure how illuminating this Tradeoffs pod is for those following the IRA price-setting process closely, but if you’re looking to catch up quick, it’s a good overview, and it quotes a lot of the people you probably want to hear from.