ICER Update 10.21.19

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

  1. ICER released an updated Draft Evidence Report assessing the comparative clinical

effectiveness and value of treatments for rheumatoid arthritis (RA). After initially publishing an earlier version of this Draft Evidence Report on September 26, 2019, ICER’s internal reviewers identified the need to reevaluate some of the assumptions and calculations in the report to better align their economic modeling with how patients transition between these therapies in the real world. In the updated model, patients that are failed by first-line treatment now transition to a market basket of targeted immune modulators, instead of palliative care. Also, because clinical differentiation between these therapies is uncertain over time, they will now analyze their cost-effectiveness in the first year of use, instead of over a patient’s lifetime.

EXCELSIOR ACTION POINT: Thank you for your patience in waiting for the release of this revised Draft Evidence Report. The comment period has been extended as well, and I am happy to see how many of you have taken the opportunity to be involved with the ICER development process by submitting comments based on your own plans’ experience.

  1. ICER also released a Final Evidence Report and Report-at-a-Glance assessing the comparative clinical effectiveness and long-term value for money of rivaroxaban (Xarelto®, Janssen Pharmaceuticals), and icosapent ethyl (Vascepa®, Amarin Pharma). ICER’s report on these additive treatments for cardiovascular disease (CVD) was reviewed at the September 2019 public meeting of the Midwest Comparative Effectiveness Public Advisory Council (Midwest CEPAC), one of ICER’s three independent evidence appraisal committees.

“While aspirin and statins have become cornerstone therapies for treating cardiovascular disease, treatments like rivaroxaban and icosapent ethyl appear to provide additional benefits for certain patients who have an elevated risk of


major cardiovascular events,” said David Rind, MD, ICER’s Chief Medical Officer. “Input from clinical experts confirmed that the ideal target population for treatment is very large, and therefore, despite being priced in a cost-effective manner, these additive treatments could pose a short-term budgetary challenge for the health system depending on how real-world uptake evolves. In these situations, it is critical for all stakeholders to work together to ensure that pricing and coverage arrangements don’t create barriers to these beneficial therapies, while balancing the need to deliver quality health care for all patients.”

EXCELSIOR ACTION POINT: It is important to recognize that the impact of this Final Evidence Report is more about the potential incremental impact of Vascepa, and comparatively less about any incremental impact associated with Xarelto use.

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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