ICER Weekly View: April 5, 2019

From the desk of David Whitrap

Good morning everyone. We are excited to announce that Pamela Bradt, MD, MPH, has joined ICER as our new Chief Scientific Officer. Dr. Bradt brings a wealth of experience as a physician and HEOR leader, and her experience in both industry and academic settings will serve ICER well as we continue our mission of helping the US health system achieve fair pricing, fair patient access, and continued incentives for future pharmaceutical innovation. What’s more, Pam is a super person.

Now let’s take a look at this week’s headlines:

  • ICER in the News: Our final report on the SMA therapies, Spinraza and Zolgensma.
  • Pharmaceutical News: Federal transparency bills, one PBM’s approach to reduce patients’ spending on insulin, why some insurers don’t always prefer generics, the “catch-and-kill” of an experimental cancer drug, financial settlements for illegal patient assistance programs, diagnosing a patient’s inability to afford prescription drugs, new websites delivering “restaurant-menu medicine,” and the disruption of a disruptive supply chain startup.

ICER in the News

On Wednesday, we published our Final Evidence Report on Spinraza and Zolgensma, treatments for spinal muscular atrophy. In addition to recognizing the treatments’ substantial clinical benefits, our independent appraisal committee reflected on emotional testimony provided by families affected by the disease and voted to affirm several important broader, non-clinical benefits of both therapies. Despite these clinical benefits and contextual considerations, however, Spinraza’s current price and Zolgensma’s potential price (based on public statements made by the manufacturer) exceed traditional thresholds for cost-effectiveness. As stated by our Chief Medical Officer, Dr. David Rind: “These treatments will be covered by US insurers regardless of the pricing, but the ripple effect of pricing decisions like these threatens the overall affordability and sustainability of the US health system.”

ICER Issues Final Report on Spinraza and Zolgensma, Provides Policy Recommendations Related to Pricing and Coverage of Treatments for Spinal Muscular Atrophy

Our report was covered by several media outlets, including Reuters and Xconomy. In particular, the Xconomy piece highlights the critical role the SMA patient advocacy community played throughout our process — we’re incredibly grateful to these families.

UPDATE 1-Biogen SMA drug price, Novartis estimates for its…

Biogen Inc should slash the price of its spinal muscular atrophy (SMA) drug, and the $4 million to $5 million Novartis has said its experimental gene therapy for the disease is worth is excessive, an independent U.S. organization that reviews the value of medical treatments said on Wednesday.

Xconomy: Report: Biogen, Novartis Should Drop Prices of Billon-Dollar SMA Drugs

Xconomy Boston – A new report from a U.S. drug-pricing watchdog takes issue with the high cost of the only approved treatment for spinal muscular atrophy (SMA), a rare genetic disease that affects young children and in some cases leads to a quick death.

Pharmaceutical News

STAT’s Nick Florko summarizes a slate of potential bills that the House Ways & Means Committee may vote on soon that would require additional transparency from PBMs and drug makers.

House committee to weigh bills aimed at shedding light on high drug prices

W ASHINGTON – The House Ways & Means Committee is poised to vote on a slate of as-yet-unintroduced drug pricing bills that would require sweeping disclosures from both drug middlemen and drug makers, according to summaries of the legislation obtained by STAT.

The pricing of insulin has outraged patients and policymakers alike. In response, Cigna’s Express Scripts unit announced a new program this week where it would cap out-of-pocket costs for insulin at $25 for a 30-day supply. Patients are currently paying an average of $41.50/month, and some are paying more than $100/month.

Express Scripts Offers Diabetes Patients a $25 Cap for Monthly Insulin

Drug makers, insurers and pharmacy benefit managers face mounting pressure from Congress and the public to reduce the high list prices of drugs like insulin. Consumers whose drug benefits are managed by Express Scripts could see their out-of-pocket costs for insulin limited to $25 a month under a plan announced on Wednesday.

Bob Herman at Axios notes that there are certain instances when generic drugs are not insurers’ preferred medicine, explaining that certain brand-name products have rebates so large that the net price on the brand is lower than the generic’s price.

Generic drugs aren’t always favored. This Express Scripts memo shows how

What we found: Express Scripts currently requires pharmacies to dispense the brand-name versions of 9 medications instead of their generic equivalents, including Advair, according to a March memo obtained by Axios. If pharmacies try to fill those generic prescriptions, the claims are rejected.

This week, Sorrento Therapeutics alleged that billionaire Patrick Soon-Shiong used a “catch and kill” scheme to keep an experimental cancer drug from coming to market, keeping competition low for a rival treatment Dr. Soon-Schiong had previously co-developed.

Sorrento Therapeutics Sues Billionaire Soon-Shiong Over Development of Cancer Drug

Sorrento Therapeutics alleges billionaire Patrick Soon-Shiong and one of his companies stopped development of a cancer drug because its success would hurt sales of a rival drug Dr. Soon-Shiong invented.

This week, three more pharmaceutical companies agreed to pay large fines to settle federal allegations that the companies used charities to provide illegal copay assistance to Medicare and VA beneficiaries.

Drug makers settle allegations they usedcharities to pay kickbacks

T hree drug makers have finalized agreements with federal authorities over allegations that donations that were paid to charities actually were kickbacks to Medicare and Civilian Health and Medical Program patients as a way to cover their out-of-pocket costs.

While the U.S. spends much more than peer countries on health care, we spend far less on our social safety net. In response, the American Medical Association and UnitedHealthcare this week announced new diagnosis codes to help capture information about patients’ social conditions, including their ability to pay for prescription drugs.

Doctors Propose New Diagnosis: ‘Unable to Pay for Prescriptions’ (Bloomberg)

Katie Thomas and Natasha Singer at the New York Times explored the ethical and legal questions posed by online startups that hawk prescription medications while providing access to physicians who can quickly authorize those prescriptions.

Drug Sites Upend Doctor-Patient Relations: ‘It’s Restaurant-Menu Medicine’

The sites promise easy and embarrassment-free access to erectile dysfunction and libido pills. “E.D. meds prescribed online, delivered to your door,” one said recently. “Starting at $2 per dose.” “Low sex drive? That can be optional,” another one said. “Try today – $99.”

And finally, Bloomberg’s Bob Langreth wrote a fascinatingly detailed account of Blink Health’s fast rise, and the lawsuits and feuds that are now disrupting the disruptive startup.

Blink Health Wanted to Change the Way Drugs Are Sold. Then Things Got Messy (Bloomberg)


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