BRIEF—ICER reviews the costliest price hikes that lacked clinical justification

The USA’s  Institute for Clinical and Economic Review (ICER) has published its latest report on  Unsupported Price Increases (UPI) of prescription drugs in the United States.

Among the top 10 drugs with net price increases in 2021 that had substantial effects on US spending, the ICER determined that seven lacked adequate new evidence to support any price increase.

For this year’s report, an additional three therapies were identified that had the highest increases in total population-based spending by the Centers for Medicare and Medicaid Services (CMS) from 2019 to 2020 due to increases in list prices. The ICER said it needed to examine this earlier time period because of the delay in public availability of data from CMS. The decision to add a review of therapies based solely on their increase in list pricing reflected concerns the ICER heard from patient groups that list price changes in Medicare Part B often have large effects on patients even if net prices do not change significantly.

“Increases in drug prices frequently occur without important new evidence,” said Dr David Rind, the ICER’s chief medical officer. “There remain many high-cost brand drugs that continue to experience significant annual price hikes, even after accounting for their rebates. List prices also continue to increase, and this can present real hardships to patients who must pay deductibles or coinsurance. For this reason, the medicine cost watchdog examined Medicare Part B drugs, recognizing that many patients may be responsible for up to 20% of the list price. As new legislation will limit drug-price increases for Medicare in future years, there may remain situations in which increases to list and/or net pricing will have important ramifications for patients and payers. The ICER said its UPI reports will continue to provide an explicit and independent approach to evaluate whether price increases are supported by new evidence so that the public and policymakers can have a basis for further action where needed.”