Recently, the Institute for Clinical and Economic Review (ICER) published its annual Unsupported Price Increase Report, highlighting some of the unsupported price increases that took place in 2022. ICER has published these reports since 2019, with the aim of “assessing whether new clinical evidence or other information has appeared that could support the price increases of drugs whose recent, substantial price increases have had the largest impact on national drug spending.”
Methodology
In pulling together the report, authors obtained a list of the 250 drugs with the largest sales revenue in 2022 in the United States from SSR Health, LLC. Authors then excluded the 195 drugs whose increase in wholesale acquisition cost (WAC) was less than 2% greater than the increase in the medical consumer price index. The remaining 55 drugs were then reviewed for estimates of the increase in net price spending in the US from 2021 – 2022, not due to an increase in sales volume.
Taking the fifteen drugs whose net prices were responsible for the largest impact on national drug spending, manufacturers were asked as to whether the ICER figures on change in net price, sales volume, and overall net revenue were correct. Using any manufacturer corrections, authors then created a list of the top 10 drugs based on increased spending in the United States due to increases in net price.
Which Drugs Made the List
Of the ten drugs that were reviewed for net price increases, ICER found that eight had price increases unsupported by new clinical evidence, producing a total of $1.27 billion in added costs to U.S. payers in 2022. Those eight drugs included: Humira (Adalimumab), Darzalex (Daratumumab), Ibrance (Palbociclib), Prolia (Denosumab), Xifaxan (Rifaxamin), Xgeva (Denosumab), Perjeta (Pertuzumab), and Adcetris (Brentuximab Vedotin). Of those, Adcetris and Prolia had the greatest increase in WAC (8.69% and 7.64%, respectively) and Adcetris and Xgeva had the greatest percentage change in net price from 2021 to 2022 (8.92% and 7.23%, respectively).
The two drugs with price increases with new clinical evidence were Jakafi (Ruxolitinib) and Entresto (Sacubitril/Valsartan). Jakafi’s WAC increased 8.33% from 2021 to 2022 while Entresto’s increased 7.96%. Jakafi’s net price changed 5.16% from 2021 to 2022 while Entresto increased 2.56% during the same time period.
Part B Drugs
This year, ICER also identified three therapies with the highest increase in total population-based spending by the Centers for Medicare and Medicaid Services (CMS) from 2020-2021, due to increases in unit prices. This data pulls from a year prior (2020-2021, not 2021-2022) because of the delay in public data availability from CMS.
ICER found that Nplate (Romiplostim) was a Part B drug with an unsupported price increase (6.81% list price increase from 2020-2021 and an increase in total population spending of $17 million). Darzalex (Daratumumab) had a price increase with new clinical evidence to the tune of 3.67% from 2020-2021 (for a total population additional spending of $19.4 million) as did Tyvaso (Tresprostinil) – a 7.38% list price increase from 2020-2021 and additional spending for total population of $18.2 million.
Limitations on the Analysis
ICER notes that it does not “currently have the capacity to perform full economic analyses in conjunction with the evaluation of clinical evidence for the drugs in its UPI reports” but instead “our assessment focused on whether new evidence existed that could justify a price increase.”