Congress is considering legislation that could force drugmakers to pay steep rebates to Medicare for patent-protected drugs that have price increases exceeding inflation, as well as subject a limited number of high-cost drugs to price negotiation.
ICER’s report could further fuel that debate on Capitol Hill and suggests a list of drugs and companies that might face price restraints should legislation advance.
The group uses a methodology the federal government could follow in its hunt to restrain costs, looking for drugs with significant healthcare spending and large increases. ICER started with 250 of the top-selling drugs in the U.S. in 2020, and excluded 228 that had list-price increases 2% or less above the medical consumer price index.
The group also excluded drugs for which increased prescription volume had a bigger impact on spending and, from there, identified the top 10 drugs for which net price increases were the biggest factor. Two more, PTC Therapeutics’ Emflaza and Vanda Pharmaceuticals’ Fanapt, were added based on public input, as the research protocol for the report allowed.
Besides the three aforementioned drugs, Novartis’ Promacta; Biogen’s Tysabri; Bausch Health’s Xifaxan; Supernus Pharmaceuticals’ Trokendi; AbbVie’s Lupron Depot; and Horizon’s Krystexxa were identified as having unsupported price increases.Together, the “unsupported” price increases for the seven drugs added $1.7 billion in spending last year, with Humira accounting for most, ICER said.
The price increases could help explain why Humira’s 2020 revenue nearly matched its 2018 record of $19.9 billion despite increasing biosimilar competition outside the U.S. In 2021, Humira is on track to exceed $20 billion in sales.
ICER also noted three drugs with new clinical data that could support price increases taken by their makers. Those were AbbVie’s Venclexta, Novartis’ Entresto and UCB’s Cimzia. The report pointed out, however, that the new clinical evidence doesn’t necessarily justify a price increase.