ICER Update 04.08.2019

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

Here is this week’s ICER recap:

  1. This week ICER published its Final Evidence Report on Spinraza and Zolgensma, treatments for spinal muscular atrophy. In addition to recognizing the treatments’ substantial clinical benefits, the ICER independent appraisal committee reflected on emotional testimony provided by families affected by the disease and voted to affirm several important broader, non-clinical benefits of both therapies. Despite these clinical benefits and contextual considerations, however, Spinraza’s current price and Zolgensma’s potential price (based on public statements made by the manufacturer) exceed traditional thresholds for cost-effectiveness. As stated by ICER Chief Medical Officer, Dr. David Rind: “These treatments will be covered by US insurers regardless of the pricing, but the ripple effect of pricing decisions like these threatens the overall affordability and sustainability of the US health system.”

    EXCELSIOR ACTION POINT: These two drugs are prototypes for everything positive and negative about the U.S. pharmaceutical industry – large capital investments giving life to innovative ideas that treat conditions that were heretofore untreatable…and priced at prices that are demonstrably unaffordable under any system of payment. It will be interesting to see Zolgensma’s final pricing as early estimates had it pegged possibly as high as $4.5 to $5 million for the one-time infusion. ICER will certainly be able to claim some credit should the final pricing come in substantially lower than that preliminary estimate.

If you would like to discuss these ICER activities, 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 week!

Bob has more than 30 years of diverse experience in the pharmacy industry. Over the course of his career, Bob has led clinical and PBM operations teams in successfully managing more than $4 billion in annual drug spend. This was also while limiting per-member-per-year spending growth to levels that have simultaneously drawn industry acclaim and consistently high levels of member and payer satisfaction.

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