ICER update gives boost to Tremfya, risankizumab for psoriasis
- The Institute for Clinical and Economic Review (ICER) last week published an updated report on targeted immunomodulators for plaque psoriasis, revisiting its earlier work in the space with analysis of several new drugs that have come onto the market.
- The New England Comparative Effectiveness Public Advisory Council, one of ICER's three evidence appraisal committees, voted that both Johnson & Johnson's Tremfya and AbbVie's risankizumab offered a net health benefit over TNF-alpha inhibitors. Tremfya's price, however, did not fall within ICER's cost-effectiveness range.
- ICER and the council found evidence to be supportive of a greater benefit to IL-17s, and some IL-23s compared to select TNF inhibitors, long the mainstay treatment for inflammatory conditions like psoriasis.
TNF-alpha inhibitors, such as Humira (adalimumab), Remicade (infliximab) and Enbrel (etanercept) maintain a dominant hold in the market for psoriasis treatments.
Newer targeted immunomodulators have recently come to market, however, such as the three more recently approved IL-17 inhibitors. J&J's Tremfya (guselkumab) and AbbVie's experimental risankizumab — both IL-23 blockers — could give physicians and patients yet more options.
However, many payers require patients to undergo step therapy or "fail-first" strategies, in which patients have to try older and lower-cost drugs before they can move on to more costly but potentially more effective drugs. This process can even repeat when patients move to a new insurer.
While ICER is known for criticizing high price tags for new drugs, this latest report is supportive of use of the new targeted biologics and suggests step therapy may not be the best approach.
"Despite reasonable cost-effectiveness for many of the agents, step therapy continues to be the dominant approach among most insurers, and patients and clinicians reiterate that it delays improvements to patients' quality of life," an ICER spokesperson said in a statement.
ICER calls for insurers that continue to use step therapy to put processes in place that ease patient burden, such as permitting individuals switching to a new insurer to bypass step therapy, or removing requirements for higher out-of-pocket costs for "later-step" treatments.
Express Scripts' efforts around this were noted as a model for coverage policy. The PBM renegotiated contracts to eliminate step therapy, creating a formulary that had an equal co-payment structure for all psoriasis drugs, according to ICER.
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