US gMG pricing isn't set by clinical differentiation alone. ICER's value-based benchmark, at under half of both approved agents' assumed price, is the ceiling every new entrant is measured against inside a hardening three-tier step-edit.
Commercial plans are building a three-tier access staircase in generalised myasthenia gravis. Tier one is traditional therapy: pyridostigmine plus at least one immunosuppressant (azathioprine, mycophenolate, or prednisone). Failure of that regimen opens tier two, the FcRn antagonists efgartigimod and rozanolixizumab, which carry broad generalised-MG labels with no serology restriction. Tier three is the C5 complement inhibitors, which require AChR-antibody positivity and, at many plans, prior failure or intolerance of an FcRn agent first. ICER's 2021 review, which assessed eculizumab and efgartigimod in the anti-AChR-antibody-positive population, set efgartigimod's value-based price at $18,300-28,400 a year and eculizumab's at $13,200-19,400, against assumed prices of roughly $418,400 and $470,200 respectively, both judged low long-term value for money.
Efgartigimod's cycle-dosing model is the distinctive payer-economics feature a pricing strategy has to reckon with: four weekly infusions per cycle, with cycle frequency driven by clinical response rather than a fixed annual schedule. Typical net annual cost lands near $225,000, varying with the number of cycles a given patient needs, and Part B benefit routing adds per-cycle prior-authorisation and MG-ADL or QMG documentation burden rather than a single annual approval. Rozanolixizumab and zilucoplan entered in 2023 without their own ICER assessment, pricing into the same staircase that efgartigimod's review already defined. UCB's dual-asset position, an FcRn agent and a C5 agent both in market, means it participates on whichever side of the step-edit a payer imposes.
US gMG pricing — the three-tier step-edit staircase and its ICER-set ceiling
| Tier | Agent(s) | ICER Value-Based Price | Assumed / WAC Price |
|---|---|---|---|
| 1 — Traditional immunosuppression | Pyridostigmine + azathioprine/MMF/prednisone | Not assessed (generic backbone) | Low-cost generic; no PA beyond diagnosis |
| 2 — FcRn antagonist | Efgartigimod, rozanolixizumab | $18,300-28,400/yr (efgartigimod, ICER 2021) | Efgartigimod ~$418,400/yr assumed price |
| 3 — C5 inhibitor (AChR+ only) | Zilucoplan, eculizumab, ravulizumab | $13,200-19,400/yr (eculizumab, ICER 2021) | Eculizumab $470,200/yr WAC |
Sources: ICER 2021 — Eculizumab and Efgartigimod for the Treatment of Myasthenia Gravis: Final Evidence Report; FDA Drugs@FDA label serology restrictions; efgartigimod net-price reporting in trade press 2023.
What this model answers
Every section answers a named commercial question your team is asking, scoped to your asset.
Delivers
- ICER's 2021 efgartigimod and eculizumab value-based price ranges
- the assumed-price-to-VBP gap for each
- the pricing ceiling a new entrant should model against
Delivers
- Step-edit architecture and PA criteria by tier
- AChR-antibody-positive gating for the C5 tier
- the population-versus-price trade-off at each staircase position
Delivers
- Cycle-dosing mechanics and the ~$225K net-annual-cost benchmark
- Part B routing and per-cycle PA burden
- the GTN waterfall components a new entrant's pricing model must decompose
Custom model delivered in 72 hours.
Commission This ModelWhat's inside
- Why ICER's value-based ceiling, not clinical differentiation, decides a new agent's viable launch price
- Pressure-tested against both existing 'low value' verdicts before the rest of the model is built out
- How ICER's 2021 methodology sets the value-based price range for each approved agent
- The assumed-price-to-VBP gap efgartigimod and eculizumab both already show
- Traditional immunosuppression, then FcRn antagonist, then AChR+-restricted C5 inhibitor
- PA criteria and population gating at each tier
- How the 2023 entrants priced into a staircase efgartigimod's ICER review had already defined
- What the analogue set supports for a new entrant's defensible price
- Efgartigimod's four-weekly-infusion cycle model and the ~$225K net annual cost it produces
- Part B routing, per-cycle PA burden, and the GTN components decomposed line by line
- Which pricing assumption moves the ICER verdict most
- PBM rebate exposure at different net-price scenarios
- Tier-entry timing and step-edit positioning strategy
- Conservative, base, and aggressive revenue scenarios
- The open pricing questions your team must close before launch price is locked
- Structured for an internal pricing committee session
Included with every brief
How AXLRx builds this model
Prepared by MoatRx analysts.
Every AXLRx pricing model is built from primary regulatory and payer sources, ICER technology assessments, FDA labelling, and live payer policy documentation, not secondary summaries. Findings are independently verified before inclusion.
US myasthenia gravis pricing sources: ICER's 2021 Eculizumab and Efgartigimod Final Evidence Report, FDA Drugs@FDA labelling for serology-restricted indications, and commercial payer prior-authorisation policy documents.
- Efgartigimod and eculizumab ICER value-based price ranges and assumed prices verified against the ICER 2021 Final Evidence Report
- Three-tier step-edit architecture and AChR-antibody-positive C5 gating verified against FDA label serology restrictions and commercial PA policy documents
- Cycle-dosing net annual cost benchmark verified against trade press reporting on efgartigimod net pricing
Frequently asked questions
Commission this model
AXLRx delivers myasthenia gravis pricing strategy models built for market access and pricing teams navigating the US ICER benchmark and step-edit architecture. Custom model in 72 hours.
Specify your indication, payer segment, and comparator scope.
AXLRx analyst confirms pricing mechanism assumptions and step-edit position before building.
Research-verified pricing model in 72 hours with optional analyst readout.