Over the years, the Institute for Clinical and Economic Review (ICER) has emerged as a champion in the fight against high U.S. drug costs. In its third report on unsupported price increases (UPI), the institute is taking aim at seven meds that it argues have gone up in price without justification from new data.
Among the group, AbbVie's prolific rheumatoid arthritis med Humira drove the largest increase in U.S. drug spending, according to a report released Tuesday. Novartis' Promacta and Biogen's Tysabri clinched the no. 2 and no. 3 spots, respectively. Elsewhere, drugs from Bausch Health, Supernus Pharmaceuticals and Horizon Pharmaceuticals made the list. In addition, another AbbVie med ranked near the bottom of the list.
Using pricing data from 2019 and 2020, ICER pegged Humira's net price increase at 9.6% and its wholesale acquisition cost (WAC) increase at 7.3%, resulting in an increase to U.S. drug spending of $1.395 billion, the report says. The total impact on U.S. drug spending of all seven products ICER flagged was $1.67 billion, suggesting Humira was largely to blame for new spending unsupported by new clinical data.
Year-over-year price hikes have “slowed considerably since ICER began issuing these UPI reports,” David Rind, M.D., ICER’s chief medical officer, said in a statement. Still, certain high-cost drugs continue to get more expensive, and “[t]he most extreme of these is Humira, with an ever-escalating US price that contrasts starkly to its falling price in every country where Humira currently faces biosimilar competition,” he said.
AbbVie sees things differently. In a response included in ICER's report, the company said that "the UPI report is published without adequate context or clarity for why ICER feels justified in making such inferences." Specifically, the company pointed out that ICER doesn't perform full value assessments for the therapies included in its report.
AbbVie said it sent ICER dozens of references to support updated safety and efficacy data on Humira and Lupron—another medicine on ICER's list. Between 2019 and 2020, prostate cancer medicine Lupron's WAC increased by 7.5% and its net price climbed 5.9%, resulting in $30 million additional U.S. drug spending.
Meanwhile, Novartis' severe aplastic anemia (SAA) drug Promacta drove the second-highest increase in U.S. spending at $100 million, followed by Biogen's multiple sclerosis med Tysabri at $44 million, ICER says. Promacta's WAC jumped 7.2% from 2019 to 2020, while its net price increased 14.1%, ICER said. For its part, Tysabri's WAC lept 7.1% and its net price increased 4.2%.
"Novartis is committed to investing in research for diseases with high unmet need, like immune thrombocytopenia and severe aplastic anemia," a company spokeswoman said over email. The drugmaker takes a value-based approach to pricing, she added. "We provided ICER with significant new clinical and health economic data on [Promacta], as well as examples of ongoing investment, that it failed to consider in its assessment," she said.
Humira is the only drug to appear in all three pricing reports, ICER noted. ICER's first UPI, published in October 2019, flagged seven drug cost increases that cost Americans an extra $4.8 billion between 2017 and 2018. Over those two years, Humira saw an average net price increase of 15.9%, resulting in a net impact on U.S. drug spending of more than $1.8 billion.
ICER's second UPI report, released in January, focused exclusively on 2019 and again flagged seven drugs that led to an extra $1.2 billion in annual drug spend. Between 2018 and 2019, Humira's WAC climbed 6.2% and its net price 2%, leading to a net impact on U.S. drug spending of an additional $66 million.
"Even after factoring in rebates and other concessions, Americans paid an estimated $1.4 billion more on Humira in 2020 than they would have if the treatment’s net price remained where it was at the end of 2019," an ICER spokesperson said of the latest report over email.
The drug's U.S. net price has increased an estimated 29.6% from the beginning of 2017 to the end of 2020, according to ICER. Humira's increase isn't just a "one year blip," ICER's spokesperson added.