ICER weighs in on Medicare price negotiations with new appraisals of BMS' Eliquis, J&J's Xarelto

As a new age of price negotiations dawns in the U.S., drug cost watchdogs at the Institute for Clinical and Economic Review (ICER) are laying out their stance on two popular blood thinners.

Monday, ICER submitted a special report (PDF) to the Centers for Medicare & Medicaid Services (CMS) weighing evidence on Bristol Myers Squibb and Pfizer’s Eliquis and Bayer and Johnson & Jonhson’s Xarelto to treat nonvalvular atrial fibrillation (NVAF), the condition for which both drugs garner most of their prescriptions.

Xarelto and Eliquis make up two of the 10 drugs set to face the first round of Medicare price negotiations under last year's Inflation Reduction Act.

To estimate the comparative therapeutic benefit of Eliquis and Xarelto in NVAF, ICER pitted each drug against both warfarin and dabigatran, two old standard-of-care therapies. 

At various cost-effectiveness thresholds, Eliquis can command between a $1,260 and $4,350 annual premium to warfarin, ICER says. Versus dabigatran, that threshold ranges from $240 to $530.

For Xarelto, meanwhile, ICER endorsed a $1,110 to $3,920 annual premium to warfarin. The group said the drug should cary no premium over dabigatran.

At the start of 2022, the list prices for a month’s supply of Eliquis and Xarelto were $529 and $516, respectively, according to a report by Patients for Affordable Drugs. By comparison, a month’s supply of warfarin was about $10.

ICER figures its report could help CMS set initial offer prices and assess counteroffers from drugmakers, president Steven Pearson, M.D., said in a statement.

“We recognize that our report will be one of many inputs CMS may consider, and we hope that it will help them as they build a reliable and transparent drug price negotiation process on behalf of the American people,” he said.

If CMS ultimately calls upon ICER’s expertise, the watchdog could assume a role somewhat like that of England’s National Institute for Health and Care Excellence, which reviews evidence on new medicines and negotiates prices.

That’s a possibility many in the U.S. pharmaceutical industry have long feared.

Meanwhile, as the Inflation Reduction Act negotiations play out, industry is pushing back. In a series of lawsuits, major drug companies and industry groups argue the law violates their constitutional rights. 

But even as the companies take the law to task in the courts, they've agreed to play ball in the early talks. This past Sunday represented a major deadline for the law, when companies involved in the first round of talks had to tell the government whether they planned to proceed.

In statements, representatives for Johnson & Johnson, Merck, AstraZeneca and Bristol Myers Squibb and Boehringer Ingelheim said the companies would participate.