The same drugs that appear on state transparency reports identifying costly drugs also appear in an independent research institute’s report on drugs whose rapidly rising prices were not supported by new clinical evidence on the drugs’ safety or efficacy.
The Institute for Clinical and Economic Review (ICER), an independent research organization that objectively evaluates prescription drugs and other health care services, released its first annual report on unsupported drug price increases in October. All of the drugs ICER identified with unfounded price hikes also appear on states’ lists of their costliest drugs and/or lists of drugs causing the highest cost growth in states. According to ICER, unsupported price increases have cost the nation $5.1 billion over the last two years.
California, Maine, Oregon, and Vermont have reported data from public and private payers regarding their drug spending as required by state transparency laws. These reports include “top 25” lists of drugs that account for:
- The highest total costs (based on price and utilization), and
- The highest growth in costs over the past year.
Many of the same drugs made appearances in “top 25” lists across states (see Table 1).
Table 1: Drugs appearing on “top 25” lists in three or more reporting states.
|Condition||Highest Total Cost or Highest Cost Growth Drugs Across States|
|Diabetes||Lantus Solar, Novolog, Januvia, Metformin, Victoza|
|Arthritis||Stelara, Cosentyx, Enbrel, Humira (Syringe and Pen)|
|Hepatitis C||Harvoni, Epclusa|
|Multiple Sclerosis||Copaxone, Tecfidera|
The National Academy for State Health Policy (NASHP) compared the high-cost drugs reported by these states with ICER’s report on drugs with unsupported price increases. The table below lists drugs that are posing affordability challenges across states and that also appeared on ICER’s “unsupported price increase” report.
Table 2: Drugs with unsupported price increases that are creating affordability challenges for states.
|Drugs with Unsupported Price Increases*||Condition||Among Top 25
Highest Total Cost Drugs in:
|Among Top 25
Highest Total Cost Growth Drugs in:
|Humira||Arthritis||California, Maine, Oregon, Vermont,||California, Oregon, Vermont|
|Truvada||HIV||California, Oregon||California, Oregon|
|Neulasta||Low white blood cell count||Oregon, Vermont||Oregon|
|Tecfidera||Multiple sclerosis||California, Maine, Oregon, Vermont||Oregon|
*Identified by ICER.
The ICER report raises an important question, if new clinical evidence on safety and efficacy isn’t behind rising drug prices, then what is? A new wave of tougher state transparency measures, including a 2019 Maine law, An Act To Further Expand Drug Price Transparency,
will have the ability to shine a light on net drug prices – and profits – in order to guide effective state policy responses. The new Maine law requires reporting from entities across the entire drug supply chain, including manufacturers, pharmacy benefit managers, wholesalers, and health plans.
ICER will publish its Unsupported Price Increase Report every October, offering states the opportunity to rely on an evidence-based method for evaluating information reporting from drug manufacturers.
In addition to addressing the challenges created by drug price increases, states are also facing the launch of new drugs with record-high prices. The nonprofit organization 46brooklyn, which works to improve the accessibility and usability of US drug pricing data, recently published a report, Drug Price Increases Have Slowed, but New Analysis Shows Launch Prices Pushing Costs into Orbit, that highlights this trend as well as the market dysfunction that occurs when the introduction of generic drug competition fails to create downward pressure on prices. A 44-state coalition is currently pursing legal action against manufacturers for generic price fixing.