As the United States embarks on a new era of drug price negotiations, the Institute for Clinical and Economic Review (ICER), renowned for its vigilant oversight of drug costs, has presented its perspective on two widely-used blood thinners. On Monday, ICER submitted a specialized report to the Centers for Medicare & Medicaid Services (CMS), evaluating the evidence surrounding Bristol Myers Squibb and Pfizer’s Eliquis and Bayer and Johnson & Johnson’s Xarelto, specifically for the treatment of nonvalvular atrial fibrillation (NVAF). This condition constitutes the primary indication for both drugs, making their prescriptions highly prevalent.
Eliquis and Xarelto are among the ten medications slated for the inaugural round of Medicare price negotiations under the Inflation Reduction Act, which was enacted last year.
In order to gauge the comparative therapeutic benefits of Eliquis and Xarelto in the context of NVAF, ICER conducted assessments against two established standard-of-care therapies: warfarin and dabigatran.
ICER’s findings indicate that, at various cost-effectiveness thresholds, Eliquis could warrant an annual premium ranging from $1,260 to $4,350 over warfarin. In comparison to dabigatran, this premium falls within the range of $240 to $530.
For Xarelto, ICER recommended an annual premium between $1,110 and $3,920 compared to warfarin. However, the group suggested that Xarelto should not carry any premium over dabigatran.
Notably, at the beginning of 2022, the list prices for a one-month supply of Eliquis and Xarelto stood at $529 and $516, respectively, as reported by Patients for Affordable Drugs. In contrast, a month’s supply of warfarin cost approximately $10.
ICER anticipates that its report could serve as a valuable resource for CMS in establishing initial price offers and evaluating counteroffers from pharmaceutical companies. President Steven Pearson, M.D., emphasized the importance of this report in assisting CMS as it strives to establish a transparent and dependable drug price negotiation process on behalf of the American public.
While the possibility of ICER’s involvement in pricing negotiations looms, the US pharmaceutical industry has expressed concerns, as the situation could mirror the role played by England’s National Institute for Health and Care Excellence, which reviews evidence on new medicines and negotiates prices—a prospect that has long raised apprehensions within the industry.
However, despite legal challenges by major drug companies and industry associations asserting that the Inflation Reduction Act infringes on their constitutional rights, many of these companies have indicated their willingness to participate in the initial discussions. A critical deadline recently passed, requiring companies involved in the first round of negotiations to inform the government of their intentions. Representatives from Johnson & Johnson, Merck, AstraZeneca, Bristol Myers Squibb, and Boehringer Ingelheim have affirmed their commitment to participate in these negotiations.