Daily Pharmacy News

Get your free subscription started now. Just enter your email address below.

Top-Selling Branded Drugs in Medicare Have Low Benefit Ratings

Health technology assessment (HTA) organizations in Canada, France, and Germany give low added benefit ratings to many drugs that are top sellers in the U.S. Medicare system, a study shows. This could portend interesting times ahead in the U.S., since the recently enacted Inflation Reduction Act of 2022 authorizes Medicare to negotiate prices of top-selling drugs based on therapeutic benefit compared with existing treatment options (in addition to other factors). “When negotiating prices for these drugs, Medicare should ensure they are not priced higher than reasonable therapeutic alternatives,” the authors conclude.

The 50 top-selling single-source drugs used in Medicare Parts B and D in 2020 were categorized as high (moderate or greater) or low (minor or no) added benefit based on ratings by HTA bodies in Canada, France, and Germany. “Forty-nine drugs (98%) received an HTA rating by at least 1 country; 22 of 36 drugs (61%) received a low added benefit rating in Canada, 34 of 47 in France (72%), and 17 of 29 in Germany (59%). Across countries, 27 drugs (55%) had a low added therapeutic rating, accounting for $19.3 billion in annual estimated net spending, or 35% of Medicare net spending on the 50 top-selling single-source drugs and 11% of total Medicare net prescription drug spending in 2020. Compared with those with high added benefit, drugs with a low added therapeutic rating were used by more Medicare beneficiaries (median 387 149 vs 44 869) and had lower net spending per beneficiary (median $992 vs $32,287).”

“Although most drugs offered marginal to no benefits over other treatments already on the market, nearly 9 of 10 drugs provided important absolute medical benefits, according to ratings by Haute Autorité de Santé in France,” write the authors. “For example, dulaglutide (Trulicity), which was the fourth glucagon-like peptide-1 receptor agonist approved in the US, was rated as having important absolute benefits for treating diabetes, but only minor added benefits when compared with other available therapeutic options. One top-selling drug, mirabegron, was rated as providing insufficient absolute medical benefit in addition to low added therapeutic benefit.”

Source: JAMA