ICER Says AstraZeneca’s $10,950 Baxfendy Is Worth $1,400 to $2,500 a Year
The Institute for Clinical and Economic Review (ICER) posted its revised Evidence Report on 1 October on baxdrostat (Baxfendy), AstraZeneca’s FDA-approved hypertension drug, and lorundrostat from Mineralys Therapeutics, which is not yet approved. Added to two or three first-line drugs in short-term trials, both lowered blood pressure comparably to spironolactone or eplerenone, rated promising but inconclusive, and comparably to amlodipine, rated comparable or inferior because amlodipine has cardiovascular outcome evidence and the new agents do not. ICER’s benchmark for lorundrostat is lower still, at $760 to $1,600 a year.
ICER has handed payers the case for putting Baxfendy behind generics. The new class is rated at best comparable to amlodipine, a generic with outcome data, and the price gap runs to 87%. Expect step therapy through amlodipine and spironolactone before any plan reaches for the new class.
- AstraZeneca: the outcome gap is the pricing gap. The comparable-or-inferior rating rests on amlodipine’s cardiovascular outcome evidence, which baxdrostat lacks. Until outcome data arrive, every payer negotiation starts from a benchmark between 13% and 23% of list.
- Mineralys: the anchor arrives before the launch price. Lorundrostat’s benchmark of $760 to $1,600 sits below baxdrostat’s, and Mineralys has not announced a price. With the head-to-head evidence rated insufficient, it launches with no clinical edge to claim, a $10,950 list price to undercut and an ICER range that payers will quote first.
- Signposts: the 29 October vote and outcome data. The Midwest CEPAC votes on the report on 29 October. ICER’s chief medical officer David Rind says the hoped-for advantages, fewer side effects and fewer clinical events, are not yet supported, so cardiovascular outcome data for either drug is what could move the rating against amlodipine.