Price hikes for some Medicare therapies unsupported by clinical benefits data – Report

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Price hikes for some Medicare therapies unsupported by clinical benefits data – Report

By Bhanvi Satija

Dec 6 (Reuters) – The three costliest therapies under Medicare health insurance in the United States saw price hikes in 2020 but there was not enough evidence of new clinical benefits, the Institute for Clinical and Economic Review (ICER) said on Tuesday.

Horizon Therapeutics’ (HZNP.O) gout treatment Krystexxa’s list price increased by 12%, which led to an additional out-of-pocket expense of $3,210 per patient being spent on average. Under many insurance plans, patients may be responsible for paying a percentage of the list price.

ICER, a group that reviews the value of medicines, said drugmakers hiked prices on seven of the 10 costliest prescription drugs in 2021 too, without enough clinical evidence justifying the hike. This led to an increase in drug spending by $805 million in the U.S. compared with a rise of $1.67 billion in 2020.

A Reuters analysis found that drugmakers continue to launch new medicines at record-high prices, even after President Joe Biden’s signature Inflation Reduction Act was passed. The law allows the government to choose 10 drugs to negotiate from among the 50 costliest drugs for Medicare, a government healthcare program for people aged 65 and older or disabled.


The other two costliest therapies under Medicare Part B, which covers medicines received in a doctor’s office, include Seagen’s (SGEN.O) cancer drug Adcetris and Ipsen’s (IPN.PA) injection Somatuline Depot. Both therapies led to an additional cost of over $1,000 per patient on average in 2020.

“There remain many high-cost brand drugs that continue to experience significant annual price hikes, even after accounting for rebates. List prices also continue to increase, and this can present real hardships to patients who must pay deductibles or coinsurance,” said David Rind, ICER’s chief medical officer.

ICER said its report focuses on whether enough new clinical data exists that could help justify price hikes and is not a full cost-effectiveness analysis of the therapies.

Reporting by Bhanvi Satija in Bengaluru; Editing by Krishna Chandra Eluri

Our Standards: The Thomson Reuters Trust Principles.

Source: Reuters