(Adds details, shares)
By Natalie Grover and Caroline Humer
Sept 29 Horizon Pharma Plc said it
would pay pharmacy benefit manager Express Scripts Holding
$65 million to settle litigation related to
after-market rebates for three of its medicines.
Express Scripts, the largest manager of U.S. drug benefits,
in November sued Horizon for a breach of contract, seeking
$166.2 million in rebates related to Duexis, Rayos and Vimovo.
Horizon contested the claim and contended that Express
Scripts had breached the rebate agreement.
Under the settlement, both companies will be released from
claims relating to the litigation without admitting any fault or
"We are returning the money to our clients, based on their
respective rebate agreements for these Horizon drugs," Express
Scripts spokesman Brian Henry told Reuters.
Rayos is a rheumatology treatment, while Duexis and Vimovo
are used for pain relief. The three accounted for more than half
of Horizon's net sales of $757 million in 2015.
Prescription benefit managers (PBMs) negotiate drug benefits
for health plans and employers and maintain a list of covered
drug benefits, called a formulary, that determines which drugs
patients can easily buy.
They often extract discounts and after-market rebates from
drugmakers in exchange for including their medicines on the list
with low co-payments.
Horizon said on Thursday that it is in discussions with
Express Scripts to add Duexis and Vimovo to its coverage list
after removing the drugs last year.
The settlement clears the path for a contract negotiation
with Express Scripts, which currently accounts for about 30
percent of all covered patients in the United States, Mizuho
Securities analyst Irina Koffler said.
If Horizon can also contract with UnitedHealth Group Inc's
Optum unit, which covers another 20 percent of lives,
then the company could achieve its goal of 80-85 percent
coverage on these brands, she added.
Separately, Horizon said it had signed a rebate agreement
with the PBM Prime Therapeutics, securing formulary status for
primary care medicines Duexis, Pennsaid 2%, Vimovo and Rayos,
starting Oct. 1.
Last month, the drugmaker announced it had secured coverage
for Duexis and Vimovo with CVS Health Corp.
"Together, we estimate Prime and CVS/Caremark manage roughly
35 percent to 40 percent of national claims," Goldman Sachs
analyst Stephan Stewart wrote in a note.
Dublin, Ireland-based Horizon's shares slipped about 1
percent in morning trading on the Nasdaq.
(Reporting by Natalie Grover in Bengaluru and Caroline Humer in
New York; Editing by Maju Samuel)