• Industry lobbying group PhRMA on Thursday warned the use of cost-effectiveness estimates like those developed by the Institute for Clinical and Economic Review could force seniors to switch from their preferred treatments if adopted in Medicare Part B, citing a new analysis produced for PhRMA by Xcenda.
• The white paper from Xcenda, which is owned by Amerisource Bergen, found that between 59% and 93% of Medicare Part B patients treated for rheumatoid arthritis, multiple sclerosis, lung cancer or multiple myeloma would face barriers to access if the government program used ICER’s framework to set coverage.
• It’s the latest example of PhRMA’s efforts to push back against ICER. The cost watchdog has stirred up drugmaker ire by publishing reams of research finding many new drugs to be overpriced relative to their clinical benefit. “What this brochure actually shows is that several drug makers need to lower prices to reflect the value their treatments provide patients,” an ICER spokesperson shot back.

Debate over the causes of — and solutions to — rising drug prices in the U.S. has put PhRMA on the defensive. The industry group has responded with high-profile ad campaigns showcasing biomedical advances, and with academic-styled research designed to counterbalance work by groups like ICER.

ICER’s profile has risen steadily in parallel with the stepped-up scrutiny of drug pricing. The U.S. does not have any formal government body tasked with assessing the cost and value of new drugs, unlike some countries in Europe such as the U.K. and Germany. To a certain extent, ICER has filled the vacuum, issuing cost-effectiveness assessments of numerous drug classes and new treatments.

Past analyses have found drugs for rheumatoid arthritis, multiple sclerosis, lung cancer and multiple myeloma to be overpriced — the same four therapeutic areas analyzed by Xcenda in its report.

In order to reach its conclusions, Xcenda estimated the number of Medicare Part B patients receiving treatment with an ICER-analyzed drug for those four diseases in 2016, noting whether or not the therapy in question was judged to be cost-effective.

Medicare Part B currently isn’t able to push patients to certain drugs through a formulary as private payers frequently do. Xcenda’s analysis, therefore, is a hypothetical scenario, albeit one that has been considered before.

Still, the report gives PhRMA another opportunity to push back against ICER’s approach to valuing drugs, which the industry group frequently criticizes as “one size fit all.”

“We support advancing these tools from being focused on rigid, budget driven methodologies toward more flexible approaches that include perspectives of what patients value,” said PhRMA CEO Stephen Ubl in a May 31 statement.

PhRMA has actually thrown its support behind moving toward value-based care, but remains wary of the type of analysis performed by ICER.

For its part, ICER called the PhRMA-sponsored research a distraction from how drugmakers actually price their therapies.

“What this brochure actually shows is that several drug makers need to lower prices to reflect the value their treatments provide patients,” said David Whitrap, VP of communications at ICER, in an emailed statement.

“From ICER analyses, we know that for conditions like rheumatoid arthritis and multiple sclerosis, many therapies were cost-effective only four or five years ago, before repetitive annual price hikes catapulted them beyond traditional ranges for cost-effectiveness.”

Some drugmakers, including Sanofi and Regeneron, have begun to work more closely with ICER on drug pricing, reflecting the group’s growing influence.

Tapping ICER’s work, the two companies in March signaled willingness to cut the price of their heart drug Praluent (alirocumab) if payers agreed to drop barriers that have to date slowed uptake of the PCSK9 inhibitor. In May, the pharmacy benefit manager Express Scripts inked a deal to do just that.