On Tuesday, Celltrion announced that its metastatic colorectal and breast cancer treatment, Vegzelma (bevacizumab), has successfully secured reimbursement by being added to the formularies of two major U.S. pharmacy benefit managers (PBMs).
Vegzelma has been designated as a preferred drug in the public and private insurance formularies of Express Scripts (ESI), one of the top three PBMs in the U.S., as well as in the public insurance formulary of another major PBM, Optum. This preferred status makes it easier for healthcare providers to prescribe the drug and reduces out-of-pocket costs for patients, potentially boosting prescription rates.
Reimbursement for ESI’s public insurance and Optum began on July 1, while ESI’s private insurance will start reimbursement in January next year.
The three largest PBMs in the U.S. pharmaceutical market wield considerable influence, controlling roughly 80% of the entire insurance market. Without inclusion in PBM formularies, patients must pay full price for medications, making access to expensive treatments virtually impossible.
With this PBM listing, Vegzelma has secured over 35% reimbursement coverage in the U.S. insurance market, establishing a stable foundation for prescriptions.
According to IQVIA, a pharmaceutical market research firm, Vegzelma captured approximately 10.6% market share in the U.S. as of May, breaking into double digits for the first time since its launch and showing continued growth.
This recent formulary inclusion is expected to accelerate Vegzelma’s market share expansion by adding momentum from new insurance reimbursements to its existing growth in the open market.
Celltrion plans to pursue negotiations for listings with other major PBMs to further boost Vegzelma’s growth trajectory.
A Celltrion spokesperson stated that with Vegzelma now listed as a preferred drug in the formularies of major U.S. PBMs, it anticipates a significant increase in prescription rates. It will continue negotiations for Vegzelma’s inclusion with other major PBMs to maintain this positive momentum.