On its annual list of price hike offenders, ICER calls out Bausch's Xifaxan, J&J's Invega

It’s December. Time to find out who’s been naughty and nice.

In the pharma world, it’s the Institute for Clinical and Economic Review (ICER) that decides which companies should get a lump of coal in their stockings.

ICER renders judgment by way of its annual report on unsupported price increases (UPIs). The independent, nonprofit research institute breaks down which companies jacked up prices of drugs without evidence of any new clinical benefit. ICER then ranks the drugs by how much the increases drove additional spending in the U.S.

The winner this year is Bausch’s irritable bowel syndrome blockbuster Xifaxan. The company hiked its net price from 2020 to 2021 by 12%, resulting in an increase in spending of $175 million.

“Increases in drug prices frequently occur without important new evidence,” David Rind, M.D., ICER’s chief medical officer, said in the report. “There remain many high-cost brand drugs that continue to experience significant annual price hikes, even after accounting for their rebates.”

Coming in a close second was Johnson & Johnson’s schizophrenia drug Invega Sustenna, which had a 7% net increase, costing the system an additional $170 million in spending.

Janssen, owned by Johnson & Johnson, was one of the few that responded to a request for comment.

“Janssen supports value assessment frameworks that benefit patients by evaluating clinical effectiveness and encouraging medical progress,” a company spokesperson said in an email. “ICER applies a flawed methodology and represents the perspective of insurance companies, not patients.”

Also on the list are Amgen’s osteoporosis treatment Prolia ($124 million in U.S. spending), Takeda’s ulcerative colitis drug Entyvio ($118 million), Novartis’ anemia therapy Promacta ($95 million), Otsuka’s schizophrenia med Rexulti ($68 million) and AbbVie’s hormone treatment Lupron ($55 million).

Novartis also offered a statement, saying it takes a “value-based approach to pricing which considers the benefits to patients, caregivers, employers, the health system and society.

“ICER’s approach to its UPI assessment of eltrombopag does not appropriately value eltrombopag, and its net price calculations also are inaccurate.”

While Bausch’s price increase for Xifaxan produced a $175 million increase in spending in 2021, that number pales in comparison to the top offender in 2020, AbbVie’s megablockbuster Humira. The company’s 9.6% unsupported increase led (PDF) to $1.395 billion in additional spending in the U.S., ICER determined.

This most recent report was the first of ICER’s four iterations that didn’t include Humira. Three drugs made the naughty list for the second straight year—AbbVie’s Lupron, Novartis’ Promacta and Bausch’s Xifaxan.

The most recent report also identified three additional therapies with unsupported increases which led to the highest Medicare B spending from 2019 to 2020. The earlier time period was examined because of a delay in public availability to Centers for Medicare & Medicaid Services data, ICER explained.

The drugs were Ipsen’s Somatuline Depot, Seagen’s Adcetris and Horizon’s Krystexxa, a gout medicine which had the highest per-patient annual spending increase ($3,210) attributed to an unsupported price increase.

“We examined Medicare Part B drugs, recognizing that many patients may be responsible for up to 20% of the list price,” Rind said. “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.”