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Hi Scott- To follow up:
Amarin has no indication that there was a change to UnitedHealthcare’s 2020 Commercial or Part D formulary coverages of Vascepa compared to coverage in 2019.
UHC is often slow in covering new drugs and new indications. Moreover, their commercial formularies have historically been outliers with regard to the entire category of Omega 3 products – including generic Omega 3s – which have been covered on the Non-Preferred Brand tier with a Prior Authorization requirement. And, UHC’s PA criteria for the Omega 3 category has historically restricted access to patients with Triglycerides > 500 mg/dL.
Now that Vascepa® has an FDA approved indication for CV risk reduction, we believe that UnitedHealthcare will revise their PA criteria for Vascepa to reflect the updated label. As a result, we believe that Vascepa’s access in the UnitedHealthcare Commercial business will improve during the course of 2020.
Currently, Vascepa is covered by UHC Commercial plans in the Non-Preferred Brand tier. In order to offset the higher co-payment amounts associated with such formulary coverage, Amarin continues to offer the $9 for 90-day co-pay card program to help Commercial patients minimize their out-of-pocket cost for Vascepa.
In Part D, Vascepa continues to be covered without restrictions in both the AARP and UnitedHealthcare plans. In the AARP Part D Plans, Vascepa is covered in the Non-Preferred Brand tier (as are generic Omega 3 products). In UnitedHealthcare plans, Vascepa is covered in the Preferred Brand tier for the majority of lives.
Amarin continues to engage with payers regarding their coverage of Vascepa. Within 24 hours of receiving FDA approval, Amarin communicated Vascepa’s new label to all major payers. We have meetings scheduled throughout January and February with multiple plans, including some of the largest national payers.
Hope this provides more context,
Elisabeth
