Trends in list prices, net prices, and discounts of self-administered injectable tumor necrosis factor inhibitors

San-Juan-Rodriguez, Alvaro; Piro, V.; Good, Chester B.; Gellad, Walid F.; Hernandez, Inmaculada

doi:10.18553/jmcp.2021.27.1.112

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…This is because net prices of drugs within a class tend to be relatively clustered. [24][25][26] However, if CMS opts to use as alternatives drugs outside of class, particularly those available in generic versions or belong to comparatively cheaper or more effective drug classes, this would put downward pressure on the initial price offers. The effect of the incorporation of outside of class drugs as therapeutic alternatives will be asymmetric though-the upper bound of the range of price offers will not be extended as it is capped by the statutory ceiling.…”

Section: Implications and Complexities Associated With Selecting Ther...mentioning

confidence: 99%

Medicare drug price negotiation: The complexities of selecting therapeutic alternatives for estimating comparative effectiveness

Hernandez,

Cousin,

Wouters

et al. 2024

JMCP

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Under the 2022 Inflation Reduction Act, the Centers for Medicare and Medicaid Services (CMS) are able to negotiate prices for top-selling drugs in the Medicare Part B and D programs. In determining initial price offers, CMS will compare the prices and clinical benefits of the drugs subject to negotiation to the prices and clinical benefits of therapeutic alternatives. Despite the central role that the selection of therapeutic alternatives will play in the price negotiations, the available guidance published by CMS provides few details about how the organization will undertake this process, which will be particularly complex for drugs approved for more than one indication. To better inform the selection process, we identified all FDA-approved indications for the 10 first drugs subject to negotiation. Using 2020-2021 Medicare claims data, we identified Medicare Part D beneficiaries using each of the 10 drugs. We extracted medical claims with diagnosis codes for each of the approved indications to report the relative prevalence of use by indication for each drug. We reviewed published clinical guidelines to identify relevant therapeutic alternatives for each of the indications. We integrated the evidence on the relative prevalence of indications and clinical guidelines to propose therapeutic alternatives for each of the 10 drugs. We describe challenges that CMS may face in selecting therapeutic alternatives.

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Section: Implications and Complexities Associated With Selecting Ther...mentioning

confidence: 99%

Medicare drug price negotiation: The complexities of selecting therapeutic alternatives for estimating comparative effectiveness

Hernandez,

Cousin,

Wouters

et al. 2024

JMCP

Self Cite

View full text Add to dashboard Cite

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“…The list prices for brand name drugs have been under scrutiny in the US in recent years [1][2][3][4][5][6]. This is particularly true for the specialty drug market, which often treats complex, rare or orphan diseases.…”

Section: Introductionmentioning

confidence: 99%

Impact of list price changes on out-of-pocket costs and adherence in four high-rebate specialty drugs

Wong¹,

Seetasith²,

Hung

et al. 2023

PLoS ONE

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Background Insurers manage the cost of specialty medicines via rebates, however it is unclear if the savings are passed on to patients, and whether reducing rebates may lead to changes in patient out-of-pocket (OOP) costs and medication adherence. This study examined two drug classes to understand the impact of reducing list prices to net prices, via lower-priced national drug codes (NDCs) or authorized generics, on patient OOP costs and adherence. Methods This retrospective analysis assessed IQVIA PharMetrics ® Plus adjudicated medical and pharmacy claims for commercially insured patients. Patient OOP costs per prescription and payer drug costs were assessed for evolocumab or alirocumab (proprotein convertase subtilisin/kexin type 9 inhibitors [PCSK9is]) or velpatasvir/sofosbuvir or ledipasvir/sofosbuvir (hepatitis C virus [HCV] medications). For PCSK9is and HCV medications, the original and lower-priced versions were compared. Adherence was estimated based on proportion of days covered (PDC) (PCSK9is) and receipt of full treatment regimen (HCV medications). Results In total, 10,640 patients were included (evolocumab, 5,042; alirocumab, 1,438; velpatasvir/sofosbuvir, 2,952; ledipasvir/sofosbuvir,1,208). After list price reductions, mean payer drug costs decreased by over 60%, while patient OOP cost reductions ranged from 14% to 55% (evolocumab: 55%, p < 0.01; alirocumab: 51%, p < 0.01; velpatasvir/sofosbuvir: 30%, p < 0.01; ledipasvir/sofosbuvir: 14%, p = 0.03). Patients with coinsurance as the largest contributor to their OOP costs had the largest reductions in OOP costs, ranging from adjusted, mean values of US$135 to US$379 (>60% reductions). Six-month PDC for PCSK9is and proportion receiving full HCV treatment regimen were high with the original versions and did not substantially differ with the new, lower-priced versions. Conclusions Reducing list prices to approximate net prices (as a proxy for reducing rebates) resulted in lower patient OOP costs, particularly for those with coinsurance. Our findings suggest that future reduction of rebates may assist in patient affordability, although additional transparency is needed.

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Trends in list prices, net prices, and discounts of self-administered injectable tumor necrosis factor inhibitors

Cited by 2 publications

References 7 publications

Medicare drug price negotiation: The complexities of selecting therapeutic alternatives for estimating comparative effectiveness

Medicare drug price negotiation: The complexities of selecting therapeutic alternatives for estimating comparative effectiveness

Impact of list price changes on out-of-pocket costs and adherence in four high-rebate specialty drugs

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