ICER Update 01.22.21

Hello, everyone, and welcome to this edition of Excelsior Solutions’ ICER Update.

Here is this week’s ICER recap:

ICER has published its latest report on Unsupported Price Increases (UPI) of prescription drugs in the United States. Among the top drugs with price increases in 2019 that had substantial effects on US spending, ICER determined that seven of 10 lacked adequate new evidence to demonstrate a substantial clinical benefit that was not yet previously known. The 2019 unsupported price increases on these seven treatments, even after pharmaceutical rebates and other concessions, cost the US health system an additional $1.2 billion beyond what would have been spent if their net prices had remained flat.

“Thanks in part to increased public scrutiny on annual price hikes, higher pharmaceutical rebates, and an uptick in generic drug utilization, average net prices on brand-name drugs have remained relatively stable in the US over the past two years,” said David Rind, MD, ICER’s Chief Medical Officer.

“However, there remain many high-cost brand drugs that continue to experience significant annual price hikes, even after accounting for their rebates. Even more concerning, several of these treatments have been on the market for many years, with scant evidence that they are any more effective than we understood them to be years ago when they cost far less. As state lawmakers continue to pursue legislation that aims to limit drug-price increases when there is no clinical rationale, we hope our UPI reports continue to provide an explicit and independent approach to evaluate the evidence. If new data emerge that show a treatment may be more beneficial than what was previously understood, perhaps some level of price increase is warranted. For seven of the ten high-cost drugs we profiled in this year’s report, however, we found that the price increases lacked such justification.”


Drugs included on ICER’s UPI list had to meet the following criteria:

  • Among top 100 drugs by 2019 U.S. sales revenue
  • WAC (list) price increase more than twice as high as the medical inflation rate between 2018 and 2019
  • At top of the list of 100 drugs after net price increases, accounting for “price concessions”
  • Within the top 10 drugs on the list of drugs whose price increases, rather than volume increases, contributed to the largest increase in U.S. spending

Of the 10 drugs meeting the above criteria, ICER determined that seven of them did not have adequate evidence to support a claim of additional clinical benefit.

The ICER protocol also allowed for the public to add up to three drugs to the UPI list even if they did not meet the criteria above; this led to Amgen’s Enbrel (entanercept) being included on the list.

The seven drugs are listed below:

  • Enbrel (etanercept)/Amgen: 8.9% net price increase
  • Invega Sustenna/Invega Trinza (paliperidone palmitate)/Janssen: 10.7% net price increase
  • Xifaxan (rifaximin)/Salix: 13.3% net price increase
  • Orencia (abatacept)/BMS: 7.4% net price increase
  • Tecfidera (dimethyl fumarate)/Biogen: 3.7% net price increase
  • Humira (adalimumab)/AbbVie: 2.0% net price increase
  • Vimpat (lacosamide)/UCB: 5.6% net price increase

Fortunately, the impact of several of these products on your pharmacy benefit plan is already being mitigated through the implementation of practical, common sense utilization and formulary management tactics & strategies that we have already discussed with many of you.

As always, if you would like to discuss the potential impact of these, or any prior, ICER reports, or any other aspects of your Pharmacy Benefit Plan, simply reach out to your Excelsior Solutions account team and we will be happy to quickly set up a call.

Until next time!

Bob Kordella, RPh, MBA

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