Prescription Drugs Covered under Medicare Part B Scrutinized as Part of ICER’s Annual Unsupported Price Increase (UPI) Report

As anticipated, the drug pricing watchdog group, the Institute for Clinical and Economic Review (ICER), published its fourth annual Unsupported Price Increase (UPI) Report on prescription drugs in the United States. The analysis found that seven (7) of the top 10 drugs with net price increases in 2021 caused the greatest increase in drug spending and lacked adequate new clinical evidence to support the price increase. All three (3) Medicare Part B drugs examined were noted to have “net price increase[s] unsupported by new clinical evidence.”

Why this matters:

ICER continues to assert its influence as the “de facto” health technology assessment (HTA) body in the United States. It is not surprising that this year, in the wake of the attention the Inflation Reduction Act brought to drug pricing, that it expanded its UPI assessment to include drugs covered through Medicare Part B. The non-profit organization has historically positioned itself to address issues of growing national concern and this year’s report reflects continued scrutiny of prescription drug prices as well as costs – both health systems costs as well as costs for patients: 

  • At the federal level, the Inflation Reduction Act included provisions to limit drug price increases beyond the rate of inflation.
  • At the state level, more governments are establishing Prescription Drug Affordability Boards (PDABs) and enacting legislation to control drug spending.
  • Patient groups continue to champion medication access and affordability.
    • The addition of Medicare Part B drugs was added in response to input from patient groups who noted that list price increases directly affect individuals who are required to pay a percentage (up to 20%) of that price out of pocket.

What life science manufacturers should know:

ICER’s 2022 UPI Report marks the beginning of anticipated analyses on drug price increases, with analyses from GoodRx and SingleCare expected early next year.

If you are considering a price increase in January:

  • Be cognizant of the spotlight on drug pricing, especially with the enactment of the Inflation Reduction Act, as policymakers will undoubtedly be monitoring how manufacturers respond to the drug pricing provisions. 
  • Prepare for any reputational impact in the short term when price increases are announced.  
    • Therapies that are top contributors to drug spending in the US are typically the ones that are called out by media and other stakeholders.
  • Ensure you have a robust communications strategy for state-level engagement with the increased interest in drug pricing from states.
  • Reiterate patient assistance programs and patient access initiatives to minimize the impacts of price increases which can be translated to out-of-pocket costs for patients.

About the Author:

Sarah Brawner is part of the Syneos Health Communications’ Reputation and Risk Management Practice where she helps clients navigate the complex policy environment and develop value and access campaigns. She has worked with organizations across the health ecosystem and excels at translating complex positions into powerful, reputation-building messages.