At the recent Milken Institute’s Future of Health Summit in Washington, DC, Centers for Medicare and Medicaid Services (“CMS”) Administrator Seema Verma spoke about new drug launch prices and posed the question “What is too high?”
As reported by FierceHealthcare, Verma discussed Sovaldi, Gilead Sciences’ Hepatitis C cure, that launched at nearly $100,000 a year and which “the public and Congress … balked at.” Verma added, “Now we have a half a million-dollar drug and one million-dollar drug and the question is: ‘When does that end?’” This was possibly in reference to a CAR-T cancer therapy, with a launch price of $475,000, and a new gene therapy for blindness, priced at $850,000. Verma also noted that “there are about ‘50 more of these in the pipeline. The system is not sustainable as is.’”
However, when questioned about House Speaker Nancy Pelosi’s plan to give the Department of Health and Human Services (“HHS”) the ability to negotiate lower drug prices, Verma was skeptical, noting that she supports more negotiation, but is unconvinced that “big government” acting as the negotiator is the solution. “[W]e’ve had so many problems in healthcare that can be rooted back to government policy and it is difficult to move things in the government … I don’t want to have just one choice and have the government making all the choices for me,” she added.
Instead, Verma pointed to the current system of private negotiators to give beneficiaries more choice, as well as to value-based pricing. Verma has also previously supported generic competition to address pricing, noting that it is “critical,” and has lauded Food and Drug Administration (“FDA”) leadership for accelerating the approval of generics and biosimilars. Again, pointing to Sovaldi, Verma noted that it cost $1,000 per pill when it entered the market in 2014, but by 2016 a generic competitor had entered the market with a price that was 45% less than Sovaldi.
Verma has previously been criticized as being disrespectful of innovation. Verma disagrees, saying that the administration is “supportive of innovation,” however, quoting HHS Secretary Azar, “[t]here’s little difference for a sick patient between a miracle cure that hasn’t been discovered and one that is too expensive to use.” Verma added “innovation cannot be an excuse for exploitation,” and noted that “[w]e must change this unsustainable trajectory. Our country’s future depends on it.”