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Competition for AbbVie's Humira gains momentum with new price report

Two rheumatoid arthritis treatments, one by Roche Holding Ltd. subsidiary Genentech and another by Sanofi and Regeneron Pharmaceuticals Inc., hold more net health benefit as single therapies than the traditional market leader sold by AbbVie Inc., price watchdog experts unanimously voted.

Actemra from Roche Genentech and Kevzara from Sanofi and Regeneron are both more effective as single therapies than AbbVie's Humira, concluded experts gathered by the Institute for Clinical and Economic Review to examine 11 targeted immune modulators used to treat moderate to severe rheumatoid arthritis.

The conclusions, published April 7, largely lined up with ICER's March 10 draft document, which said that eight of the 11 drugs were more cost-effective for moderate to severe rheumatoid arthritis than Humira.

A majority of ICER experts also voted that Actemra beat Humira for long-term value for money, a measure bringing together clinical and cost effectiveness with other considerations such as potential disadvantages.

Kevzara is still under FDA review, as is Eli Lilly & Co.'s Olumiant, which was also included in the analysis. Kevzara was rejected last year by the FDA due to manufacturing concerns; Sanofi's head of media relations Ashleigh Koss told S&P Global Market Intelligence that the companies expect a new decision in the second quarter of this year.

When looking at the medicines used in combination with conventional disease-modifying anti-rheumatic drugs, voters were split on whether there was enough evidence to say that Olumiant offer a better net benefit than Humira. The other combination therapies were largely judged to be comparable to Humira combinations.

Representatives for both Regeneron and Eli Lilly spoke on a policy roundtable during ICER's March meeting on the drugs.

ICER having increased impact on pricing

With favorable cost-effective analysis on their side, Regeneron and Eli Lilly could shift their pricing strategies, Evercore ISI senior equity analyst Umer Raffat suggested in an April 10 note, adding that investor interest in ICER reports has grown. However, Raffat also said the ICER's use of Humira's net price to calculate cost-effectiveness was a significant issue.

The actual price for drugs, or the price negotiated by pharmacy-benefit managers to pass on to payers, is often not publicly disclosed. The ICER panel said in a statement on the report that payers should be more transparent on the role of discounting and rebates in formularies. It also advised that PBMs and payers should focus on streamlining step therapy and prior authorization protocols, even removing step therapy if drug prices fall.

Raffat also pointed out that Actemra and Kevzara were only voted as superior to Humira when used alone, not in combination, as Humira is generally used.

He said Evercore ISI reached out to AbbVie on the study, and the company said there were "significant flaws" in ICER's methodology.