Two PBMs' pharmacy chiefs
tell AIS Health they agree with a new report by the Institute for Clinical and
Economic Review (ICER), which finds that several biologic medications to treat
uncontrolled moderate to severe asthma may modestly reduce disease exacerbations
and improve quality of life. But the analysis also concludes that because the
drugs are costly, the entire therapy class would need price discounts of at
least 50% to be considered cost-effective.
The report focuses on the
five FDA-approved monoclonal antibody therapies targeting pathways involved in
either the allergic or type 2 inflammatory phenotypes of asthma in moderate to
severe cases: Genentech's Xolair (omalizumab); GlaxoSmithKline's Nucala
(mepolizumab); Teva's Cinqair (reslizumab); AstraZeneca's Fasenra
(benralizumab); and Sanofi/Regeneron's Dupixent (dupilumab).
ICER says its review
suggests these currently approved biologic medications are safe and effective.
Yet, the report states, "None of the drugs prevented most exacerbations
requiring systemic corticosteroids or improved average daily quality of life to
a degree considered clinically significant. Thus, the net health benefit for
all five drugs is at best incremental."
Meanwhile, the
per-treatment wholesale acquisition cost among the five products ranges from
$878.80 to $4,752.11, according to ICER, with annual treatment prices of
between $27,800 and $31,000. "Due to high biologic treatment costs, the
cost-effectiveness estimates did not meet commonly-cited cost-effectiveness thresholds,"
the report concludes.
"The study is well
done and we agree with the findings," says Mesfin Tegenu, R.Ph., president
of PerformRx, LLC. "Like most biologics with marginal clinical benefit but
associated with astronomical cost, theses biologics for asthma are also more of
a last effort than they are a viable treatment option. For that reason we
follow clinically solid, strict criteria to properly administer these products."
David Lassen, Pharm.D.,
chief clinical officer of Prime Therapeutics LLC, says the PBM's chief clinical
concern with the biologics for asthma with type 2 inflammation is that
"there isn't a definitive measure and/or biomarker to determine when and
if there is a response to therapy with these products — and when/if therapy
should be changed or adjusted."
"Additionally, we
are concerned with lack of evidence on the long-term safety of these
products," Lassen adds. "We believe more comparative effectiveness
data is needed to clinically differentiate these products."
From Health Plan Weekly
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