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Express Scripts already lists Amgen’s Aimovig as a preferred treatment on its largest formulary, but requires patients first try two older preventive therapies and a triptan, a family of generic drugs that treat acute migraine. Lilly’s Emgality will be covered under the same terms. Amgen, Lilly and Express Scripts will also begin next April to refund part of the drug cost if a migraine patient stops treatment within 90 days, indicating that the medication does not work for them or causes too many side effects. That refund, between 25 percent and 30 percent of the drugs’ list price, would be returned to Express Scripts clients, and comes in addition to the rebates it has already negotiated.

39 MILLION MIGRAINE SUFFERERS “Everyone in the chain is taking some accountability for the cost of the drug,” Carter said, adding that the refund means the manufacturers are sharing financial risk if the drugs do not work as well as claimed, Around 39 million Americans suffer from migraine headaches, according to the Migraine Research Foundation, Worldwide migraine drug sales could reach $8.7 billion by 2026, according to analytics firm GlobalData, But Carter estimated that only about 128,000 of the 83 million people who get their prescription drug benefits through Express Scripts will be good candidates for the migraine-prevention drugs, Under the Migraine Care Value program that will launch next April, Express Scripts will have its specially trained pharmacists, nurses and other staff assess appropriate care and access to therapies for patients, The PBM, which is being acquired by Cigna Corp, created a similar program in 2015 that sharply limited the use of two deco fan pink mother of pearl cufflinks novel, and expensive, cholesterol drugs - from Amgen and partners Regeneron Pharmaceuticals and Sanofi SA..

For the new migraine drugs “the challenges will likely be right out of the gate, seeing if patients are responding to the therapy,” Carter said. The drugmakers have already tried to pre-empt efforts to limit access to the new treatments. Amgen and Lilly are offering initial free samples directly to patients and their doctors. For patients covered by commercial insurance who are still having trouble getting reimbursed, the companies have programs to supply the drugs at no cost for up to another 12 months. All three companies also have programs that cover much of an individual’s out of pocket costs under a commercial insurance plan. Some large health insurers, such as Anthem Inc, have similar coverage terms for Aimovig, requiring patients to document the number of headaches they suffer each month, and show that they have tried older migraine treatments first. Others, including Blue Cross/Blue Shield plans in states like Pennsylvania and Kansas, only cover prescriptions for the new drugs from - or in consultation with - a neurologist or headache specialist, and not a primary care doctor.

MEXICO CITY (Reuters) - Amazon.com Inc is scouting for land in central Mexico for a fourth distribution center in the country, sources said, aiming at a bigger slice of the burgeoning e-commerce market in Latin America’s second-largest economy, The retail titan’s target is Queretaro state in the industrial center of Mexico, where it is looking to hire a developer to build a large hub, deco fan pink mother of pearl cufflinks two real estate professionals familiar with Amazon’s property hunt said, They asked not to be named because Amazon has not announced its plans..

The expansion plan highlights Amazon’s intent to plant roots beyond Mexico’s bustling capital, banking on the nation’s potential to grow into an e-commerce engine of Latin America. Online shopping in Mexico comprised just 3.0 percent of total sales last year, according to market research firm Euromonitor International, but it is projected to more than double by 2022, reaching $14 billion. “Mexico’s digital economy has great potential. We expect it to keep growing in the future,” said Brian Huseman, Amazon’s vice president for public policy, at a recent event in Mexico City promoting efforts to get more Mexican companies on its platform.

“Amazon is here for the long run,” he said, The company has considered several properties in Queretaro, and was looking for 50 acres where it could commission a more than one million-square-foot warehouse, about the size of 17 football fields, plus office space, one of the sources said, Amazon declined to comment, Queretaro, 114 miles north of Mexico City, is within a day’s reach of Monterrey and Guadalajara, two of Mexico’s most populous regions, It also sits in a cluster of middle-class cities in the Bajio, deco fan pink mother of pearl cufflinks a region dense with automotive and aerospace plants..

Most of the state’s industrial parks sit along the so-called “NAFTA highway,” a key artery for companies in Mexico receiving goods from the United States and Canada under the North American Free Trade Agreement. An updated pact was agreed last month and is expected to preserve cross-border commerce once it becomes law. The parks are also within several miles of the Queretaro Intercontinental Airport that handles cargo. Amazon’s expansion to Queretaro would be part of the company’s bid to reel in shoppers with fast deliveries while keeping a lid on shipping expenses.

“It’s all about deco fan pink mother of pearl cufflinks speed to market and keeping costs low,” said Marc Wulfraat, president of logistics consultancy MWPVL International Inc, Amazon, which began selling physical goods in Mexico in 2015, already operates three warehouses just outside Mexico City with about 1.5 million square feet, That space is equivalent to just 1.0 percent of its vast U.S, logistics footprint, according to MWPVL, Still, it has scaled up faster in Mexico than in Brazil, which MWPVL says has 665,400 square feet..

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