Pfizer to price COVID treatment Paxlovid at $1,390 per course

Reuters

On Wednesday, Pfizer said it will set the US list price for its COVID-19 antiviral treatment Paxlovid at $1,390 per five-day course when it moves to commercial sales after government stocks run out.

Last December, ICER provided updated value-basing pricing for Paxlovid. We found that the treatment would Achieve Common Thresholds of cost-effectiveness if priced between $563-$906 per treatment course. 

Medicare lifts limit on brain scans for Alzheimer's patients

Axios

Medicare administrators have finalized plans to broaden coverage of PET scans for Alzheimer's patients — a move that potentially boosts the fortunes of treatments like Eisai and Biogen's Leqembi.



Earlier this year, we released our Final Evidence Report assessing the comparative clinical effectiveness and value of Leqembi. ICER analyses suggested the treatment would Achieve Common thresholds for cost-effectiveness if priced between $8,900 – $21,500 per year. Leqembi's list price is $26,500 per year.

Gene Therapy Cost Effectiveness: US ICER Supports Million-Dollar Prices

Pink Sheet

At ICER's September 29th public meeting on arsa-cel for metachromatic leukodystrophy, an independent appraisal committee reviewed ICER's Evidence Report and deliberated on the treatment's comparative clinical effectiveness and other potential benefits.

Using weighted analyses across all patient subpopulations, ICER found that arsa-cel would achieve Common Thresholds for cost-effectiveness if priced between $2.3M – $3.9M.

How to Pay for Million-Dollar Cures

Bloomberg

Lisa Jarvis, a Bloomberg Opinion columnist covering biotech, penned an op-ed on paying for new gene therapies. She stated:

“Everyone from pharma firms to patient advocacy groups, state Medicaid directors and the federal government is trying to solve the cost problem. The health-care community still has time to put sensible plans in place as gene therapies come on stream for more diseases.

But if we fail to take advantage of that narrowing window, everyone loses: The inevitable hodgepodge of coverage approaches will leave many without access to transformative treatments; companies will abandon promising therapies that they can’t actually sell; and new technologies will never really take flight. That’s why we can’t let the perfect be the enemy of the good when it comes to testing payment models for these drugs. Some useful if imperfect precedents already exist. What’s most important is that these models ensure equitable access to these treatments for any eligible patient.” 

Bloomberg also cited our recent sickle cell disease Final Evidence Report on gene therapies lovo-cel and exa-cel. Current evidence suggests that both treatments would achieve common thresholds for cost-effectiveness if priced between $1.35M to $2.05M.

Should Insurance Cover Wegovy, Ozempic and Other New Weight-Loss Drugs?

Scientific American

ICER recently spoke with Scientific American about our recent obesity management assessment:

“David Rind, chief medical officer at the Institute for Clinical and Economic Review, a nonprofit organization that estimates fair prices for the U.S. health system [stated], ‘Will this create more pressure on insurers to cover these drugs? Maybe,’ he says. ‘But I think the exchange is insurers saying, ‘You’re going to have to pay more for premiums,’ which will turn some people away.’”

Our 2022 obesity management Final Evidence Report included subcutaneous semaglutide (Wegovy, Novo Nordisk), liraglutide (Saxenda, Novo Nordisk), phentermine/topiramate (Qsymia, Vivus Pharmaceuticals), and bupropion/naltrexone (Contrave, Currax Pharma). We found that semaglutide used for weight loss would achieve common thresholds for cost-effectiveness if priced between $7,500 – $9,800 per year. Even at a fair price, only 0.2% of eligible patients could be treated before creating a significant budget impact problem.

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CMS wants Part D plans to be on their best behavior

Politico

CMS will keep a close eye on Medicare Part D plans to ensure they don’t raise out-of-pocket costs for older adults on any of the 10 drugs chosen for price negotiations when negotiated rates come online in 2026.

Plans in Medicare Part D, the program’s prescription drug benefit, must cover any drug chosen by CMS for price negotiation. However, the agency said it will monitor whether plans increase the use of tools like prior authorization, which requires insurer approval before prescribing a pharmaceutical, on any of the drugs.

NASHP, Families USA Press States To Build On IRA Via Affordability Boards

Inside Health Policy

As Medicare begins to start price negotiation for 10 selected prescription drugs, key advocacy groups are pressing states to build on the national effort with their own initiatives to lower drug costs. A key strategy is enactment of state prescription drug affordability boards (PDAB) -- an approach being actively pushed by Families USA and the National Academy for State Health Policy, which notes four states already have such boards in place. Six other states have legislation moving through their legislature.

Colorado is furthest along, but Maryland, Minnesota and Oregon have approved legislation. Colorado is in the midst of conducting affordability reviews for five previously selected drugs while the other states are still in early stages of establishing board members and picking which drugs to focus on. Connecticut, Michigan, New Jersey, Rhode Island, Vermont and Washington have live legislation. PDAB bills failed in Virginia and New Mexico.

How the secrecy of middlemen inflates drug prices

The Hill

Researchers at the USC Schaeffer Center for Health Policy & Economics examined the roles of PBMs in the drug pricing system:

“Most people or organizations buying drugs, like self-insured employers, do not know how great the gap is between what they are paying and what drug makers receive. Research by our organization, USC’s Schaeffer Center, shows that intermediaries in the system make higher profit margins than the average firm in the S&P 500 after accounting for the riskiness of investments in different industries.”

Family premiums in employer plans set to rise 7%: KFF survey

Fierce Healthcare

Family premiums for employer plans are set to rise by 7% on average this year, one year after virtually no growth, according to a new analysis from KFF.

KFF expects that family premiums will average $23,968 this year, according to its annual benchmark survey. The report projects that employees will contribute $6,575 toward that premium on average, up $500 from last year's survey. People who work at firms with fewer than 200 employees contribute $2,500 more to their premiums than those at larger firms, according to the study.

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