Recently, the Institute for Clinical and Economic Review (ICER) published its Unsupported Price Increase Report of prescription drugs in the United States, finding that 7 out of the top 10 drugs with net price increases in 2021 lacked adequate new evidence to support any price increase.
10 Prescription Drugs with Highest Price Increases in 2021
ICER reviewed prescription drugs to identify the top 250 drugs by 2020 United States sales revenue with wholesale acquisition cost price increases that exceeded the consumer price index plus 2%. Then, they identified the drugs with the highest net price increases after rebates and concessions, vetting the net price increases with manufacturers, and ultimately concluding with the top 10 drugs whose price increases contributed to the largest increase in United States spending.
Taking those ten drugs, ICER then determined whether during 2021 there was any new moderate or high-quality evidence for the drugs that would show “a substantial improvement in net health benefit beyond what was previously known,” using input from manufacturers and reviewing evidence available in published studies.
The seven drugs (brand/generic) were: Xifaxan®/Rifaximin ($174.7 million increased drug spend due to net price change); Invega Sustenna®-Trinza®/Paliperidone ($170.4 million increased drug spend due to net price change); Prolia®/Denosumab ($123.8 million increased drug spend due to net price change); Entyvio®/Vedolizumab ($118 million increased drug spend due to net price change); Promacta®/Eltrombopag ($94.9 million increased drug spend due to net price change); Rexulti®/Brexpiprazole ($67.9 million increased drug spend due to net price change); and Lupron®/Leuprolide ($54.9 million increased drug spend due to net price change).
The three drugs that did show important new clinical evidence and were in the top 10 drugs with a price increase were Cosentyx®/Secukinumab, Tremfya®/Guselkumab, and Jakafi®/Ruxolitinib. ICER did note, however, that while new evidence did exist to indicate that a price increase may have been warranted for these three therapies, ICER did not conduct a full cost-effectiveness assessment and therefore, the new evidence may or may not justify the level of price increase.
Medicare Part B Drugs with Increase and No Supporting New Evidence in 2020
Additionally, according to the report, three Medicare Part B drugs with high list price increases in 2020 lacked adequate supporting new evidence, directly raising annual out-of-pocket expenses for Medicare patients by up to $3,200 per year. This information is delayed a year behind the other price increase statistics due to the availability of data from the Centers for Medicare and Medicaid Services (CMS).
Krystexxa®/Pegloticase increased by an average per-patient annual amount of $3,210; Adcetris®/Brentuximab Vedotin increased by an average per-patient annual amount of $1,640; and Somatuline® Depot/Lanreotide increased by an average per-patient annual amount of $1,210.
ICER Comments
“Increases in drug prices frequently occur without important new evidence,” said David Rind, MD, 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, we 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. Our 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.