ICER Weekly View: January 25, 2019

From the desk of David Whitrap

In the national conversation around drug pricing, there remains a stark divide between 1) those who believe that the current market dynamics are unsustainable, and 2) those who stand to profit by preserving the status quo.

I recently learned that “status quo” is actually an abbreviated form of the original Latin phrase, “in statu quo res erant ante bellum” (i.e., “in the state in which things were before the war”). While that translation is probably a bit too ominous for a policy debate around drug prices, you’ll see in the industry news below that the defenders of the status quo sure seem to be gearing up for battle…

This week, let’s take a look at:

  • ICER in the News: a new international collaborative to establish best practices for determining value-based prices for potential cures, and media coverage of our forthcoming “Unsupported Price Increases” report.
  • Pharmaceutical News: Policy proposals from the President and Congress to control US drug prices, the industry’s record-high lobbying effort to minimize the effect of these proposals, what in the world is going on with list prices for insulin, and Celgene’s audacious legacy.

ICER in the News

This week, ICER launched an international collaborative to help guide value-based pricing of potential cures. The initiative will inform the 2019 update to our value assessment framework, and it will seek to build consensus across health technology assessment groups — including both the UK’s National Institute for Health and Care Excellence (NICE) and the Canadian Agency for Drugs and Technologies in Health (CADTH) — in anticipation of a rising tide of gene therapies and other potential cures. We’re accepting public input on the key methodological issues through February 20. ICER’s president, Dr. Steve Pearson, spoke with BioCentury about the project:

ICER aims to define HTA approach to gene therapies

The Institute for Clinical and Economic Review is taking the lead in defining the global health technology assessment (HTA) process for potentially curative treatments such as gene therapies, strengthening its position as the de facto HTA in the U.S. In a new collaboration with National Institute for Health and Care Excellence (NICE) in the U.K.

In addition, our forthcoming annual assessments of “Unsupported Price Increases” were reported on by Pink Sheet, BioCentury, Axios, American Journal of Managed CarePolitico, and (below) FiercePharma. We’re accepting public comment on the proposed UPI protocol through February 13.

Cost watchdog ICER lays out plans to scrutinize pharma’s costliest price hikes

The U.S. cost-effectiveness watchdog ICER plans to put its number crunching to work on price hikes. With the help of some new funding, the group plans to unveil in October its first annual list of increases that aren’t supported by new clinical evidence.

Pharmaceutical News

Bloomberg’s editorial board outlined how the new US Congress offers fresh opportunities to lower drug prices because, for once, Democrats and Republicans appear to be on the same page.

A Chance to Cure America’s Drug-Price Sickness (Bloomberg)

The new House Oversight Committee is preparing for its first hearing on drug prices next week, and reporting from STAT suggests how the committee plans to aggressively investigate manufacturers and the entire supply chain.

Democrat seeking 10 years of pharma’s pricing data in investigation – STAT

This story first appeared in D.C. Diagnosis, STAT’s weekly newsletter about the politics and policy of health and medicine, which relaunched today. Sign up here to receive it in your inbox. R ep. Elijah Cummings, the Maryland Democrat chairing the House Oversight Committee, put the pharmaceutical industry on notice this week when he launched an investigation into the industry’s drug pricing tactics.

And here in Massachusetts, Governor Charlie Baker is looking into options for reining in costs on the priciest therapies that lack any competition.

Baker backs rate-setting for high-cost drugs – CommonWealth Magazine

THE BAKER ADMINISTRATION is seeking legislative authority for MassHealth to negotiate prices directly with the manufacturers of high-cost drugs that have little or no competition and, if that effort fails to produce savings, to put the companies through a rate-setting process followed by regulatory and legal penalties if the firm fails to charge the target(…)

Rest assured, the status quo will be defended. PhRMA spent $27.5 million on lobbying in 2018 (its highest ever in a single year), BIO spent nearly $10 million (its highest, as well), and the industry’s political campaign contributions exceeded $17 million. And that $50+ million worth of influence is in addition to the aggressive lobbying by far less transparent organizations, including those that the Washington Post spotlighted this week:

Anonymous ‘ghost ship’ is among groups flooding drug pricing debate

January 22 The political war over prescription drug practices is spawning a frenzy of activity by outside lobbying groups, some with names that mask their ties to industry and one that has gone to great lengths to disguise its origins.

And what sort of war of words should we expect when these policy ideas bump up against the industries that would be affected? For a taste, let’s look at how STAT fact-checked PhRMA’s criticism of the Trump administration’s proposal to tie a drug’s US price to its price overseas. (Full disclosure: while ICER generally supports proposals that aim to minimize wasteful health care spending, we’re unsure why the US would need to outsource the nuanced work of value assessment to other countries that may have different values and budget priorities.)

Some PhRMA criticisms of Trump’s foreign drug pricing plan ring hollow

W ASHINGTON – The pharmaceutical industry’s Washington lobbying group is fighting full force to scuttle a Trump administration policy proposal that would tie the price of drugs in the U.S. to their costs abroad – and making a handful of specious arguments along the way, health policy experts told STAT.

A new report from the Health Care Cost Institute shows that list prices for insulin in the US nearly doubled over a five-year period. It’s important to note that this analysis excludes the impact of rebates, which would reduce the effect of this price hike on payers but would not offer much help to patients in high-deductible plans.

U.S. insulin costs per patient nearly doubled from 2012 to 2016: study

(Reuters) – The cost of insulin for treating type 1 diabetes in the United States nearly doubled over a five-year period, underscoring a national outcry over rising drug prices, according to a new analysis shared with Reuters. A person with type 1 diabetes incurred annual insulin costs of $5,705, on average, in 2016.

And finally, veteran reporter Matt Herper penned an important coda to the bold legacy of Celgene, which is in the process of being acquired by Bristol-Myers Squibb. Celgene pushed the boundaries of biotech, but also the boundaries of drug pricing. Matt’s concluding thought: “For the industry as a whole, this will be a big shift — and, maybe, an opportunity for change.”

How Celgene leaves a legacy of chutzpah in science and drug pricing

N ina Kjellson was just two years out of college, working as a research associate at Oracle Partners, a hedge fund in New York, when a cabbie gave her a stock tip. There was a company in New Jersey, he told her, trying to resurrect thalidomide, a drug that was infamous for causing severe birth defects, as a treatment for cancer.

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