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Weekly View
August 18, 2023
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For the past two Weekly View intros, we’ve been delving into ICER methods… so let’s keep it going! Today, I want to discuss ICER’s health benefit-price benchmark (HBPB).
Any discussion about health technology assessment must acknowledge the notion of tradeoffs. When society is forced to purchase a medical intervention at a price that far exceeds the intervention’s ability to improve patients’ health, there’s a real opportunity cost involved. And not just an economic cost, but a tangible health cost, too: rising premiums can lead to individuals dropping insurance coverage, and ultimately greater health losses for the patients who can no longer afford the care they need.
When ICER establishes a treatment’s health-benefit price benchmark, we do so with an explicit focus on these opportunity costs. Our HBPB suggests the highest US price a manufacturer should charge for a medication, based on the amount of improvement in overall health patients receive from that treatment, when a higher price would cause disproportionately greater losses in health among other patients. In short, it is the top price at which a health system can reward innovation and better health for patients without doing more harm than good.
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Let's see what happened this week... | |
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We received more coverage on our July 27th sickle cell disease public meeting, where an independent appraisal council discussed the comparative clinical effectiveness and value of two gene therapies: exagamglogene autotemcel (“exa-cel”, Vertex Pharmaceuticals and CRISPR Therapeutics) and lovotibeglogene autotemcel (“lovo-cel”, bluebird bio). The committee found that each therapy provided a net health benefit when compared to the standard of care.
Pink Sheet reflected on the last few ICER assessments of gene therapies:
“The ICER sickle cell review continues the pattern of very favorable receptions for gene therapies by the private assessment group. In fact, the clinical stories of benefit have emerged as the pre-eminent factors in the first cadre of private sector assessments of gene therapies – outweighing, at least to this point, the discussions of cost.”
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ICER’s 2022 obesity management Final Evidence Report included subcutaneous semaglutide (Wegovy, Novo Nordisk), liraglutide (Saxenda, Novo Nordisk), phentermine/topiramate (Qsymia, Vivus Pharmaceuticals), and bupropion/naltrexone (Contrave, Currax Pharma). We found that semaglutide used for weight loss would achieve common thresholds for cost-effectiveness if priced between $7,500 – $9,800 per year. The current annual estimated net price is over $13,000.
The Financial Times quoted ICER’s Chief Medical Officer, David Rind, MD:
“At current prices, ICER estimated that only 0.1 percent could be treated within five years without ‘major budget disruptions’ for the insurers. ‘The options are to move money away from other healthcare, raise premiums, or taxes if you’re the government, or manufacturers could lower the price to a cost-effective price and still make enormous amounts of money because enormous numbers of patients want this,’ Rind says.”
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The Chamber filed a motion in July for a preliminary injunction against the Medicare Drug Price Negotiation Program, claiming it would inflict “irreparable harm” on U.S. businesses and patients. The DOJ pushed back, pointing out that companies won’t feel the impact of the negotiated prices until at least 2026 and saying this case could be “fully litigated” by that point. The department also argued pausing Medicare drug price negotiation would harm the public’s interests. | | |
Pharma companies are pretty sure about the identity of many of the products on the upcoming Centers for Medicare and Medicaid Services list of the 10 drugs chosen for Medicare Part D price negotiation. But ongoing patent litigation and a lack of publicly available data on current program spending has created uncertainties about others. Pink Sheet identified 13 drugs that are strong candidates to become the first 10 drugs selected for CMS price-setting. | | |
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Last month, Mark Cuban’s Cost Plus Drugs platform announced it had reached an agreement to provide TheracosBio’s bexagliflozin (Brenzavvy) at a price of $47.85 plus shipping and handling for a 30-day supply of the agent. This move would allow bexagliflozin, which became the 5th SGLT2 inhibitor to receive approval from the US FDA in January 2023, to overcome what many have described as the greatest hurdle to SGLT2 inhibitor uptake: cost.
TheracosBio’s mission is to “provide access to new medications for patients with common diseases…Only after the drugs lose their patent exclusivity do they achieve widespread penetration in the target patient population. TheracosBio believes that appropriate pricing can meet its business needs while enabling improved access to the latest therapeutic technologies.”
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David Mitchell, a cancer patient and founder of Patients For Affordable Drugs, penned an op-ed about the Inflation Reduction Act:
"The plain facts are that Medicare sets prices for everything else it pays for in healthcare: doctors, hospitals, and tests, for example. But drug companies say they won’t negotiate and will fight having to do so using every tool at their disposal. They insist they must have the power to set prices for the drugs we buy."
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STAT’s Matt Herper delved into the current state of the U.S. drug pricing landscape:
“Cancer patients are likely dying as a result of drug shortages that occurred partly because generic chemotherapies have been allowed to become too cheap. At the same time, other patients are suffering, and perhaps dying, because the financial burden brought on by the expensive medicines they need is too high. Sit with that like a terrible Zen koan: Medicines are both too cheap and too expensive.”
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Insurers selling coverage in North Carolina, Pennsylvania and New York, among other states, told The Associated Press they won’t cover Leqembi with insurance offered on the individual market and through employers because they still see the $26,000-a-year drug as experimental.
ICER reviewed the drug and found suggested the treatment would achieve common thresholds for cost-effectiveness if priced between $8,900 – $21,500 per year.
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Want to work for a fast-paced, mission-driven organization? Look no further! ICER is looking to expand our team, which includes a diverse set of clinicians, researchers, and policy experts. | |
Health Economics
Program and Operations
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8/21: Sickle Cell Disease -- Final Evidence Report
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9/14: Metachromatic Leukodystrophy -- Revised Evidence Report
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9/25: Pulmonary Arterial Hypertension -- Draft Evidence Report
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