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Repatha is here – is your benefit plan ready?

On September 10th, 2015, Health Canada approved Repatha, which is a prescription drug indicated for patients who have a genetic disorder which prevents them from properly metabolizing cholesterol.

These patients would be best served by switching from statins to Repatha. Statins are cholesterol-lowering medications such as Lipitor, Crestor, atorvastatin, and many others.

Repatha is a biologic drug, and can cost $7,000 to $9,000 per year, per patient in Canada.

The fact that it is a ‘biologic’ means that there is no generic equivalent which can be dispensed at a lower price.

Why is this reason to take action to examine your benefit plan’s drug list?

What we know for sure: Cholesterol medications are the #1 drug category that our benefit plans pay for, in terms of either number of dispensed prescriptions, and total dollar cost. A significant segment of the population have been prescribed cholesterol-lowering medications such as ‘statins’.

What we don’t know for sure: There’s no strong indicator yet as to how many existing statin patients will be prescribed Repatha by their doctors because they have had trouble responding to their existing medications. About 1 in 500 Canadians have the genetic variant meaning that they are a good candidate for Repatha, but some experts say that there’s no telling how many people will be prescribed this new drug, and it could increase the cost of drugs under a benefit plan by as much as 37% (Reformulary Group, “Informulary”, October 2015).

Why should you care?

If anyone who asks for Repatha is allowed coverage, it could dramatically impact costs, and therefore, premiums. The cost of the drug will typically not trigger the ‘stop-loss’ or ‘pooling point’, therefore, leaving the plan sponsor to pick up the tab.

Amgen, the manufacturer, advises that only patients with the genetic disorder should be prescribed Repatha. There may be a patient assistance program for individuals with limited coverage.

What should you do?

Beneplan strongly urges all plan sponsors to elect to use the Reformulary drug plan through Beneplan and The Co-operators Life, because Reformulary will ensure that only members with the genetic disorder receive access to coverage.

Questions?

Please reach out to your group benefits representative, or contact us at 1-800-387-1670.