The Price and Value of Orphan Drugs

How do you put a price tag on a drug that offers life-altering results – but for a small group of patients? The question is becoming increasingly relevant with the rise of innovative, targeted medicine. And it’s at the heart of current debate about how the Institute for Clinical and Economic Review’s value framework applies to orphan drugs.

ICER, as it’s called, is a drug price analysis group. Using its trademark value framework, it assigns drugs a value benchmark price based upon long-term cost effectiveness and short-term budget impact. Recent ICER reports have generated price points for drugs that treat rheumatoid arthritischronic pain and other conditions.

This summer ICER released a proposal on how it might alter its framework when evaluating drugs for “ultra-rare” conditions. ICER defines the term as a disease impacting fewer than 10,000 people. Small populations make generating comprehensive clinical trials data difficult, ICER concedes. That requires the organization to tweak how it approaches these therapies.

 Read More at the Institute for Patient Access

Boomer Esiason: In search of a breakthrough for my son's cystic fibrosis

Former Bengals quarterback Boomer Esiason is co-chairman of the Boomer Esiason Foundation.

Just over 24 years ago, my son Gunnar was diagnosed with cystic fibrosis, a debilitating and unrelenting disease for which there is no cure. At the time of his diagnosis, CF was akin to a death sentence – there were no FDA-approved treatments and we could only hope that we might see a cure in time to save Gunnar’s life.

Learn more at Cincinnati.com 

***PRESS RELEASE*** New Cystic Fibrosis White Paper Defines Barriers to Treatment

White paper addresses why patients cannot access breakthrough treatments that treat the cause, not just the symptoms, of cystic fibrosis

 

WASHINGTON – Today the Cystic Fibrosis Engagement Network, a project of the Alliance for Patient Access, released a new white paper, “Making Treatment Accessible for Cystic Fibrosis Patients.” The white paper details what’s standing in the way of patient access to new treatments approved to target some of the genetic mutations that cause Cystic Fibrosis – and how addressing bureaucratic barriers could help the 30,000 Americans living with this rare disease. For the patients with specific mutations, these treatments can significantly improve lung function and quality of life.  

The white paper pinpoints two key barriers to treatment: 

1.     Medicaid barriers. Due to the expense of managing the disease, many patients with cystic fibrosis – about 45 percent – depend upon Medicaid. Criteria and processes for determining prescription drug coverage can vary by state, where Drug Utilization Reviews and Pharmacy and Therapeutics committees often decide which patients get access to certain drugs. Officials do not necessarily communicate with actual patients or confer with experts, leading to decisions that can be “outdated and inconsistent with current practices.”    

2.     Prior authorization requirements. This technique requires patients and their families to appeal to the health plan for permission to access the medication their physician prescribed. Insurers may require paperwork, tests, or proof that a patient has failed on a less expensive therapy before they approve the requested drug.

The delay can be painful, even damaging for patients with the progressive disease. 

These barriers can block vital access to advanced and long-awaited treatments. For decades, patients were able only to treat the symptoms of the disease using mucus-thinning drugs and vests that vibrate the chest cavity to help clear mucus buildup from the lungs and vital organs. 

The paper urges policymakers, advocates, patients and health care providers to work toward commonsense solutions that improve access to cystic fibrosis medications.  

 

Resources

Cystic Fibrosis Engagement Network                                           https://www.engagecf.org

Alliance for Patient Access                                                           http://allianceforpatientaccess.org

 

###