ICER Weekly View: January 4, 2019

From the desk of David Whitrap

Good morning and Happy New Year!

Each January brings optimism, fresh starts, and resolutions to be our best selves. It also sets up the annual battle: will our high-minded intentions be able to conquer well-entrenched habits? A new Congress was sworn in this week, but as of this moment, the government shutdown continues. Next week’s JP Morgan Healthcare Conference may bring all sorts of bullish optimism for the biotech sector, but will those hopes be fueled by true scientific innovation or just speculation about the next megamerger? And ICER’s own lofty mission – to help all Americans achieve sustainable access to high-value care – each year hurdles headfirst into a well-entrenched health system… a system that historically has struggled to discern when it’s getting a great value for new medicines, and when it’s getting ripped off by prices set far beyond the benefits patients actually receive. Check back next January and we’ll let you know how we’re doing.

Resolutions aside, let’s take a quick look at what’s happened since our last Weekly View:

  • ICER in the News: Our draft assessment for spinal muscular atrophy, and our final report on biologic treatments for uncontrolled asthma.
  • Health Policy Developments: The government shutdown’s effect on federal health programs, the ongoing fight over the constitutionality of the ACA, and a rare lobbying loss for the drug industry.
  • Pharmaceutical Industry Trends: Bristol’s big bet on Celgene, the latest batch of January 1st price hikes, and the pros/cons of crowdfunding unproven medical treatments.

Now, on to the news.

ICER in the News

Before the break, ICER released our Draft Evidence Report assessing the clinical effectiveness and value of nusinersen (Spinraza®, Biogen) and onasemnogene abeparvovec (Zolgensma®, Novartis/AveXis) for the treatment of spinal muscular atrophy (SMA). The draft report, which is open for public comment through January, has been reported on by several media outlets, including STAT News, Reuters, Bloomberg, Investor’s Business Daily, Endpoints News, BioPharma Dive, Vantage, and BioSpace.

Two high-priced drugs for spinal muscular atrophy called not cost effective – STAT

A pair of new medicines designed to treat spinal muscular atrophy, a rare and often fatal genetic disease affecting muscle strength and movement, may be beneficial but appear to be priced too high to be considered cost effective, according to a preliminary analysis.

Also before the break, ICER released our Final Evidence Report and Policy Recommendations on the biologic treatments for uncontrolled asthma, including dupilumab (Dupixent®, Sanofi/Regeneron), omalizumab (Xolair®, Genentech/Novartis), mepolizumab (Nucala®, GlaxoSmithKline), reslizumab (Cinqair®, Teva), and benralizumab (Fasenra™, AstraZeneca). While all five biologics modestly reduce asthma exacerbations and improve daily quality of life, each treatment would need a price discount of at least 50% to reach commonly cited thresholds for cost-effectiveness.

Health Policy Developments

While the partial government shutdown does not affect the vast majority of the federal government’s public health efforts, a few programs remain vulnerable (Kaiser Health News).

How The Government Shutdown Affects Health Programs

There seems to be no end in sight for the current partial government shutdown, the third since the beginning of the Trump administration. For the vast majority of the federal government’s public health efforts, though, it’s business as usual.

After a federal judge in Texas ruled that the entire Affordable Care Act was unconstitutional, a coalition of blue states is appealing the decision (Associated Press).

Democratic attorneys general appeal Affordable Care Act ruling, as signups stay ‘remarkably steady’

WASHINGTON – Democratic attorneys general on Thursday appealed a federal court ruling that the Affordable Care Act is unconstitutional, as new enrollment numbers underscored the staying power of the Obama-era law. The government reported that about 8.4 million Americans have signed up this year under the law, reflecting steady demand for its subsidized health insurance.

In a sprawling feature, STAT’s Nick Florko chronicles PhRMA’s unsuccessful fight against having to provide bigger discounts for Medicare Part D.

The inside story of PhRMA’s biggest lobbying loss in years – STAT

W ASHINGTON -The drug industry’s storied lobbying group isn’t accustomed to bad news – and with its small army of well-connected advocates, it’s even less familiar with surprises. For PhRMA, the news last winter was both. On Feb.

Pharmaceutical Industry Trends

Yesterday morning, Bristol-Myers Squibb announced its planned acquisition of Celgene for $74 billion. The team at STAT News analyzes what the megadeal means for the companies, the rest of the industry, and drug pricing:

“For anyone who thinks competition could help drive down cancer drug prices (tip: it has not), having two of the world’s biggest cancer companies merge isn’t going to improve things.”

9 big takeaways from the $74 billion Bristol-Celgene deal – STAT

The proposed merger of Bristol-Myers Squibb and Celgene have sweeping implications for the drug industry. Here are some of the major ones.

Another new year, another wave of drug price increases. More than 250 drugs saw price increases during the first few days of January, although these increases were generally more modest than in previous years (The Wall Street Journal).

Drugmakers Raise Prices on Hundreds of Medicines

Pharmaceutical companies are raising prices on hundreds of drugs, with Allergan setting the pace with increases of nearly 10% on more than two dozen products, according to a new analysis.

In a survey conducted by Cowen analysts, US payers are anticipating average annual drug price increases of 3-5%, and 5-7% on just the brand-name drugs (STAT News).

Payers expect drug prices to rise 3 to 5 percent annually over next three years – STAT

P resident Trump may be expecting a tremendous drop in prescription drug prices, but more than two dozen payers think otherwise: They foresee their per-unit acquisition costs rising between 3 percent and 5 percent annually over the next three years, according to a new survey by Cowen analysts.

Writing for NPR, Rachel Cohen explains why patients are crowdfunding unproven medical treatments, and why that’s concerning.

Crowdfunding Drives Funds And Attention Toward Questionable Medical Treatments

For deep-water divers who decompress too quickly, doctors may advise that they lie inside a pressurized glass tube and inhale pure oxygen to treat painful symptoms known as “the bends.” The oxygen boost is thought to reduce swelling and prevent infection.


Regular readers of Weekly View will notice that the usual author of this newsletter, Mitchell Stein, has stepped away from Weekly View to pursue other opportunities. We are forever grateful to Mitchell for helping ICER connect with each of you, and we remain committed to keeping everyone updated on ICER’s activities and perspective. 

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