Major League Baseball set a record in 2019 for home runs in the regular season. Not to be outdone, Democratic presidential candidates are shooting for a record of their own — dumbest healthcare “fixes” in a single campaign. 

Senators Elizabeth Warren and Bernie Sanders have eclipsed even Nancy Pelosi, who is sticking with the long-discredited idea of letting Medicare negotiate prices with manufacturers. That’s far too tame for Warren and Sanders, who want to replace the entire healthcare structure with Medicare for All. Not to mention canceling everyone’s medical debt and abandoning private insurance.

In the past, we’ve been able to sidestep or deflect election-year drug price brainstorms, but 2020 might be different. Given a plethora of crazy ideas, it’s not inconceivable that Congress may adopt a “moderate” approach and modify the ACA to allow Medicare price negotiations. 

So here’s an idea. Instead of doggedly defending our right to price our brands, what if we take an end run around our critics and adopt some of their tools? One of our industry’s most vocal critics is an organization known as the Institute for Clinical and Economic Review (ICER), an independently funded group created in 2015 with the objective of evaluating the cost-effectiveness of prescription drugs. 

Not surprisingly, they’re often at odds with pharma manufacturers. Of the 79 drugs ICER has reviewed, less than a third were judged to be fairly priced. In the past, our trade organization, PhRMA, has taken them to task, calling them “biased” and “simplistic.” But is an attack the best approach? 

Let’s consider the drugs ICER has reviewed favorably. Surprisingly, ICER stood up for the
price of Sovaldi for hepatitis C, even as most critics were lambasting it as “the $1,000 pill.” ICER read the data, did the math and concluded that a cure for hepatitis C easily outweighed Sovaldi’s treatment costs. 

In another, perhaps even more remarkable example, ICER agreed, after some initial balking, that the $2.125 million price for a single injection of Zolgensma was justified by its efficacy in treating spinal muscular atrophy. No complaints about a “million dollar shot.” 

The opportunity to gain support from a respected third party was not missed by decision-makers at Sanofi and Regeneron, who had been wondering how to price their new eczema drug, Dupixent. As detailed recently by Eric Sagonowsky on FiercePharma, these companies approached ICER well before the Dupixent launch. According to Sagonowsky, the final agreed-upon list price of $37,000 per year after rebates was less than what had been predicted by Wall Street analysts, but the rapid acceptance of Dupixent following launch quickly led to its current blockbuster status. The companies also set up a patient assistance program. 

ICER probably saw the Sanofi/Regeneron overture as a mixed blessing. On one hand, ICER could boast of fulfilling its mission of encouraging cost-effective drug prices. On the other hand, it would inevitably be seen as endorsing Dupixent’s cost. It’s not hard to see that if and when Medicare officials are allowed to negotiate prices, they will have scant leverage following a favorable review by an independent and trusted organization such as ICER. 

Is proactively seeking upstream price validation a complete solution to the threat of government usurpation of our business model? Not necessarily. If you’ve been burned in the past by an ICER review, you’re probably thinking I’m nuts. But if you’ve got good data and a compelling story, why not give it a try?

Sander Flaum is principal, Flaum Navigators

This article has been updated to clarify that the price referenced for Dupixent was the agreed-upon list price, before discounts and insurance, as well as the availability of a patient assistance program.

From the November 01, 2019 Issue of MM+M - Medical Marketing and Media