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With Trial Results, Should Amgen Reconsider Its Pricing For Repatha?

This Nov. 9, 2014, file photo, shows signage outside the Amgen headquarters in Thousand Oaks, Calif. (AP Photo/Mark J. Terrill, File)

With the release of the FOURIER trial, Amgen and academic investigators have provided evidence that their novel cholesterol-reducing drug, Repatha (evolcumab), can reduce risk. Among people with cardiovascular disease and well-controlled cholesterol levels on a statin, they were able to markedly reduce the cholesterol further and lower the risk of events like heart attacks and strokes by about 15%. The drug has been on the market since 2015–but this represents the first major outcomes trial of the drug. Regeneron and Sanofi have a similar drug that is also approved and their trials are still ongoing.

The cost of Repatha is about $14,000/year. Is it worth it?

Until now the pricing has been based largely on the presumption that the remarkable drop in cholesterol levels (it can drop levels by about 60 mg/dl–even if you are already on statins) would translate into remarkable risk reduction. Also, because it is delivered by injection, some people supposed it would address the issue of people forgetting to take their medications. Some experts thought it might virtually eliminate cardiovascular disease. A drop like that might be estimated to cut the risk of heart disease in half. For comparison, statins provide a much more modest reduction in cholesterol and reduce heart disease by about 20%.

Sales have been slow so far. In part because of uncertainty about the benefit.

So now we have evidence of the size of the benefit, should the pricing be adjusted accordingly? The trial indicated that for every about 70 people who received Repatha, one cardiovascular event was averted over about two years. There were no differences in the deaths. If the price of Repatha, just for round numbers, was $10,000 a year–then it would cost about $1.4 million for every event averted.

Now, that calculation is crude and about equivalent to a scribble on the back of the envelope. A more sophisticated calculation is merited–including one that takes into account the savings from the event averted–and perhaps simulates what would happen over the next 10 years. Nevertheless, with the benefit now clear, it is possible to put the benefit in the context of the cost and begin to ask: what is the drug worth to an individual and to society? Such an approach is relevant to new therapies across the spectrum of medicine.


Personally, I am glad to have a new outcomes evidence-based drug in our armamentarium. Many high-risk patients, with few other options, need strategies to lower risk. Amgen–and the other companies taking risk to bring novel therapies to market–deserve our respect. But as the costs of care continue to risk and account for an ever-growing proportion of our gross domestic product, it becomes increasingly important to pay for value–and that is what the market should bear. Not more. Not less. Now we need to grapple with the proper way to price a 15% reduction in risk.
