Nine widely-used medications have experienced substantial price surges over the past 2 years, adding $5.1 billion to overall drug spending during this time period, according to a new report.

The authors of the report, the Institute of Clinical and Economic Review (ICER) claimed 7 of the 9 drugs were lacking sufficient clinical evidence to support such price increases, but several pharmaceutical manufacturers took issue with the methodology used in the analysis.

Of the drugs listed, the ICER indicated that lenalidomide and dimethyl fumarate were the only 2 with new clinical evidence. In an published with the report, however, several manufacturers challenged ICER's methodology and findings. For example, the assessment only includes indications representing greater than 10% of use, not accounting for smaller indications such as rare diseases that may reflect improvements in net health benefit. 

In the commentary, officials with AbbVie pointed out limitations in ICER's analysis, noting that the assessment does not "adequately reflect the breadth of available high-quality evidence that demonstrates the added net health benefit of Humira."  In addition, AbbVie officials wrote that the assessment did not account for the continued development of new patientcentric enhancements, patient registries, and patient support programs. According to AbbVie, the manufacturer submitted "more than 200 scientific publications that support the value of Humira and its safety and clinical effectiveness," but ICER determined that none of the evidence fully met the review process criteria. 

"In conclusion, a reliable and complete assessment of the value of Humira should look holistically at AbbVie's investments in Humira, from clinical studies to real-world data to product enhancements that support the patient experience," AbbVie officials noted in the report. 

Below are the top 9 drug price hikes based on wholesale acquisition cost (WAC) increase, net price increase, and overall estimated increase in drug spend, according to the analysis. 

1. Adalimumab (Humira)

WAC increase: 19.1%
Net Price increase: 15.9%
Drug spending increase: $1.86 billion

Indicated for: Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, adult and pediatric Crohn disease, ulcerative colitis, plaque psoriasis, adult and adolescent hidradenitis suppurativa, and adult and pediatric non-infectious uveitis.
Adalimumab topped the list of best-selling therapeutics last year.


2. Rituxan (rituximab)

WAC increase: 17%
Net Price increase: 23.6%
Drug spending increase: $806 million

Indicated for: non-Hodgkin lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, pemphigus vulgaris, granulomatosis with polyangiitis, and microscopic polyangiitis.

3. Pregabalin (Lyrica)

WAC increase: 28.3%
Net Price increase: 22.2%
Drug spending increase: $688 million

Indicated for: Neuropathic pain associated with diabetic peripheral neuropathy, neuropathic pain associated with spinal cord injury postherpetic neuralgia, adjunctive therapy for partial-onset seizures in patients 1 month of age and older, and fibromyalgia.

4. Elvitegravir, Cobicistat, Emtricitabine, Tenofovir (EVG/COBI/FTC/TAF) (Genvoya)

WAC increase: 14.3%
Net Price increase: 21.7%
Drug spending increase: $651 million

Indicated for: HIV in antiretroviral (ART)-naïve adults and pediatric patients aged 12 years and older and to replace the current ART regimen in virologically suppressed patients.

5. Emtricitabine/Tenofovir Disoproxil Fumarate (Truvada)

WAC increase: 14.3%
Net Price increase: 23.1%
Drug spending increase: $550 million

Indicated for: to be used in combination with other antiretroviral agents for the treatment of HIV-infected adults and childred aged 12 years and older and for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV in adults and adolescents at high risk. 

6. Pegfilgrastim (Neulasta)

WAC increase: 14.6%
Net Price increase: 13.4%
Drug spending increase: $489 million

Indicated for: decrease the incidence of infection as manifested by febrile neutropenia in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia and to increase survival in patients acutely exposed to myelosuppressive doses of radiation.

7. Tadalafil (Cialis)

WAC increase: 26.2%
Net Price increase: 32.5%
Drug spending increase: $403 million

Indicated for: erectile dysfunction and benign prostatic hyperplasia

8. Dimethyl Fumarate (Tecfidera)

WAC increase: 16.7%
Net Price increase: 9.8%
Drug spending increase: $313 million

Indicated for: relapsing forms of multiple sclerosis

9. Lenalidomide (Revlimid)

WAC increase: 25.8%

According to the report, ICER received public comment that lenalidomide experienced “important price increases,” but due to uncertainties in the volume of unit sales, they were unable to accurately determine the change in drug spending.

Indicated for: myelodysplastic syndromes, mantle cell lymphoma that has relapsed or progressed after 2 prior therapies, and multiple myeloma.

Reference

Institute for Clinical and Economic Review. Unsupported Price Increase Report. October 8, 2019. . Accessed October 9, 2019.