Amarin Corp Plc (AMRN)

[sts66]

CVS Caremarks's move is not exactly a good one for patients - it will use ICER to EXCLUDE drugs, not recommend or make decisions to INCLUDE coverage for certain drugs - this also means if AMRN or a buyer doubles the price CVS would no longer be inclined to keep it on the cheapest tier:

In an ongoing war over drug prices, leading pharmacy benefit manager CVS Caremark is rolling out a new weapon that aims to limit drugmaker pricing power. The PBM plans to let clients exclude drugs based on assessments from a controversial pricing watchdog—and pharma is likely to hate the idea.

Under the program, unveiled in a drug pricing white paper, CVS Caremark will start allowing clients to exclude any drug with a quality-adjusted life years figure of more than $100,000, as determined by the Institute for Clinical and Economic Review. Health organizations use the metric to determine the cost of medicines in the context of quality and expected remaining years of life. Critics, however, have said payers can use the metric and other cost-effectiveness analyses to deny patient access to drugs.

The program will exclude drugs the FDA has deemed “breakthroughs.” In its white paper, CVS notes that the program “will focus on expensive, ‘me-too’ medications that are not cost effective, helping put pressure on manufacturers to reduce launch prices to a reasonable level.”