ICER Update 10.05.20

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

Here is this week’s ICER recap:

ICER released a Final Evidence Report and Report-at-a-Glance assessing the comparative clinical effectiveness and value of elexacaftor/tezacaftor/ ivacaftor (Trikafta®, Vertex Pharmaceuticals) for the treatment of cystic fibrosis (CF). ICER also examined new data that have become available since its May 2018 review of three related CF treatments: ivacaftor (Kalydeco®, Vertex), lumacaftor/ivacaftor (Orkambi®, Vertex), and tezacaftor/ ivacaftor (Symdeko®, Vertex). All four therapies are CFTR modulators. ICER’s report on these therapies was reviewed at the August 2020 public meeting of the California Technology Assessment Forum (CTAF), one of ICER’s three independent evidence appraisal committees. Vertex was invited to share the company’s perspective at the public meeting but declined to participate. ICER’s Chief Medical Officer, Dr. David Rind, explained the policy implications of this mixed assessment:

“CF is a devastating disease that affects the lungs and other organ systems, typically requires substantial medical care, and robs patients and families of hours each day, before taking away full years of life,” said David Rind, MD, ICER’s Chief Medical Officer. “Trikafta is a remarkable advance for the majority of people living with CF, and we encourage public and private US payers to maintain a simple process for all eligible patients to access this important treatment. Unfortunately, the manufacturer has leveraged its monopoly to set a price — costing many millions of dollars over the lifetime of an average patient — that is far out of proportion to the treatment’s substantial benefits. Patients who receive Trikafta will benefit, but misaligned pricing causes harm to patients — some with CF and some with other diseases — who are forced to delay or forego care or even to drop health insurance entirely.”

ICER’s leadership expanded upon this dual need for fair access and fair pricing in an open letter to the CF community.

EXCELSIOR ACTION POINT: This is a very rich Final Evidence Report that highlights the strong clinical value of Trikafta paired, unfortunately, with a higher price than ICER’s metrics deem reasonable. We recommend that, at minimum, you check out the Report-at-a-Glance that concisely distills down the conclusions of the full report. Despite its price, all market projections tend to indicate that Trikafta is poised to assert dominance in the CF market over the near- and medium-term as physicians become more familiar with its clinical profile.

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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