Who will pay for these miraculous new medical therapies?

The BMJ

The BMJ's Marianne Guenot interviewed ICER's President and CEO, Sarah K. Emond, MPP about gene therapies that are using cutting edge science to provide real value to patients:

"'Outcome based contracts can be an 'important tool for protecting against clinical uncertainty,' says Emond. 'In a lot of cases, even if you’re not assuming a lifetime of benefit,

many of these therapies are bringing tremendous value to patients that command prices in the millions of dollars,' says Emond. 'But not everything that’s a gene therapy comes with that robust and evidence base that can justify a million dollar price.'”

‘Completely Reasonable Price’ May Boost Coverage of Pain Drug Journavx

AIS Health

Last month, ICER released a Final Evidence Report assessing the comparative clinical effectiveness and value of suzetrigine (Journavx™, Vertex Pharmaceuticals) for the treatment of acute pain.

AIS Health discussed the report with ICER’s Chief Medical Officer, David Rind, MD:

“Although Journavx’s list price is more than 20 times higher than some generic opioids, David Rind, M.D., Chief Medical Officer at the Institute for Clinical and Economic Review (ICER), says the new medication has a ‘completely reasonable price’ and is ‘almost certainly high value’…‘It’s just worth realizing everything we’re talking about here in terms of the value of this drug is about avoiding opioid use disorder,’ Rind tells AIS Health, a division of MMIT.”  

 MUST READS



Trump pledges his support for a change to the IRA long sought by drugmakers

Endpoints News

President Donald Trump on Tuesday signed an executive order offering support for a change to the IRA’s “pill penalty,” one of the industry’s longstanding policy priorities that could affect billions of dollars in drug costs under Medicare.

The executive order on drug pricing contains a grab bag of policy proposals, some of which are opposed by the industry. The proposed change, which would have to come from Congress, would no longer treat small-molecule drugs and complex biologic prices differently under the Medicare negotiation program.

JPMorgan study: How small businesses are handling insurance costs

Fierce Healthcare

Health insurance premiums and related costs are a significant burden for small businesses, and a new study from banking giant JPMorgan Chase finds that many dropped coverage from one year to the next to mitigate the expense.

The report, compiled by the JPMorgan Chase Institute, found that about a third of small businesses canceled their coverage between 2018 and 2019.

Attorneys general want Congress to prohibit PBMs from owning affiliated pharmacies

STAT

Dozens of state attorneys general are urging Congress to pass a law prohibiting pharmacy benefit managers from simultaneously owning pharmacies, arguing such a move would boost competition and create more affordable prescription drug prices for Americans.

Their concern is these arrangements create conflicts of interest that allow pharmacy benefits managers to dominate the design of health plans for tens of millions of Americans, and also distort the distribution and pricing for prescription medicines. The companies are able to do so, the attorneys general maintained, by favoring their own affiliated pharmacies at the expense of independent drug stores.

Arkansas adopts first-in-the-nation law forcing companies to choose between running a PBM or pharmacies

STAT

Arkansas Gov. Sarah Sanders has signed a first-in-the-nation law that prohibits pharmacy benefit managers from operating both retail and mail-order pharmacies, a move designed to eliminate a conflict of interest that has been blamed for boosting the price of medicines and forcing independent pharmacies to close.

At issue is an ongoing concern that the largest pharmacy benefit managers — which are controlled by CVS Health, Cigna, and UnitedHealth Group — favor their own pharmacy operations. Critics say that by doing so, these companies not only dominate the design of health plans for tens of millions of Americans, but also distort the distribution and pricing for prescription medicines.

US CDC Panel Recommends Some 50-59 Year-Olds For RSV Vaccination

Pink Sheet

The US CDC's Advisory Committee on Immunization Practices (ACIP) voted 14-0 (1 abstention) that adults ages 50 to 59 years who are at increased risk of severe RSV disease can receive a single dose of RSV vaccine.

OTHER HEADLINES

• Reuters: Tariff wars to hit popular US-made drugs in China, regulator data shows
• STAT: Tennessee officials find Express Scripts violated law governing commercial pharmacy claims
• Pink Sheet: HHS’ Kennedy Warns US FDA Staff Against ‘Agency Capture’ By Industry, Special Interests
• Axios: Pharma tariffs could be a generics problem
• Pink Sheet: FDA Reorganization Proposal A ‘Mindless Approach To Centralization,’ Woodcock Says

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.



Current Openings:

• Research Assistant

ICER Analytics revolutionizes your ability to plan drug development, establish drug pricing, negotiate drug reimbursement, and explore new ways to apply evidence in a drive toward a health system that can achieve fair prices and fair access for all. ICER Analytics is comprised of two tools: 

• The ICER Evidence Compendium™: leverage a rapidly searchable and sortable summary of results from ICER’s library of evidence reports.

• The ICER Interactive Modeler™: analyze key aspects of over 50 economic models produced for ICER evidence reports, and update parameter inputs based on your own prices, your own data on patient characteristics, or your own assumptions about drug performance and uptake. 

Email analytics@icer.org for more information or to get started on a free 30-day trial of ICER Analytics. 

• 5/15: Retinitis Pigmentosa -- Final Evidence Report
• 5/27: Spinal Muscular Atrophy -- Draft Evidence Report
• 5/29: Multiple Sclerosis -- Evidence Report  

Learn more about ICER’s ongoing and recently completed reports:

• Multiple Sclerosis: SPMS
• Non-Cystic Fibrosis Bronchiectasis
• Retinitis Pigmentosa
• Spinal Muscular Atrophy

Email info@icer.org for more information.

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