Cancer Drug Prices Rise in the US Post Launch, Fall in Germany, Switzerland

In the US, cancer drug prices rose post-launch, whereas in Germany and Switzerland, prices for both cancer and noncancer drugs dropped, according to a study published in JAMA Health Forum.¹

High prices of new drugs are prevalent worldwide. Drug spending in the US grew by 9.4% between 2021 and 2022, with a total of about $635.5 billion in 2022.² Similar trends can be observed in European countries.¹ In Germany and Switzerland, drug expenditure increased by 5.2% and 6.5%, respectively, between 2021 and 2022; drug prices are associated with these increases.

Although previous studies have demonstrated the increasing initial drug prices in the US, especially for cancer drugs, price developments of drugs after entering the market are still not understood. Therefore, the researchers aimed to analyze post-launch price developments of new drugs approved in the US, Switzerland, and Germany between 2011 and 2022. Despite having different drug negotiation policies, they compared the US to these 2 countries since they are economically similar.

While cancer drug prices rose post-launch in the US, prices for both cancer and noncancer drugs decreased in Germany and Switzerland, highlighting the importance of considering both launch and post-launch price trends to improve medication access. | Image Credit: Oleg - stock.adobe.com

The researchers identified all new drugs approved in the US, Germany, and Switzerland during this timeframe using the publicly available databases of the FDA, European Medicines Agency, and Swissmedic, respectively. With the World Health Organization’s Anatomical Therapeutic Chemical classification system, the researchers categorized drugs as either cancer or noncancer drugs.

Prices were extracted for eligible drugs from market entry until September 30, 2023. German and Swiss prices represented manufacturer-to-wholesaler costs, while the US prices represented net prices, accounting for significant rebates. Also, treatment prices were calculated using FDA label dosing and clinical trial data, with the lowest-cost option chosen for drugs with multiple forms or packages; for longer treatments, the researchers capped costs at one year.

Also, they adjusted prices for inflation using data from the Organization for Economic Cooperation and Development (OECD), with European prices converted to US dollars based on exchange rates on September 30, 2023. Lastly, the researchers analyzed 2 cohorts. The primary cohort included all new drugs with available price data in the US, Germany, and Switzerland, while the secondary cohort focused on approved drugs with price data available in all 3 jurisdictions (US, European Union, and Switzerland).

The primary study cohort included 787 drugs: 254 in the US, 298 in Germany, and 235 in Switzerland. Of these, 88 in the US (34.6%), 100 in Germany (33.6%), and 80 in Switzerland (34.0%) were cancer drugs. Conversely, 142 drugs were included in the secondary study cohort. Of these, 65 (45.8%) were cancer drugs and 77 (54.2%) were noncancer drugs.

The median launch prices in the US increased from $29,630 (IQR, $1322-$49,691) for drugs approved in 201 to $84,240 (IQR, $9556-$131,567) for those approved in 2022. Therefore, mean launch prices increased from $31,699 to $228,658, a mean increase of 19.7% per year.

Additionally, in Germany, median launch prices increased from $26,674 (IQR, $1552-$44,476) for drugs approved in 2011 to $50,097 (IQR, $15,100-$98,243) for those approved in 2022. Consequently, the mean launch prices increased from $77,237 to $146,072, a mean increase of 6.0% per year.

Lastly, the median launch prices in Switzerland increased from $18,074 (IQR, $573-$31,206) for drugs approved in 2011 to $28,920 (IQR, $4869-$66,404) for those approved in 2022. Therefore, mean launch prices increased from $29,211 to $41,399, a mean increase of 3.2% per year. Overall, median launch prices of cancer drugs were 654%, 267%, and 723% higher than noncancer drugs in the US, Germany, and Switzerland, respectively.

After adjusting for inflation, trimmed mean prices of drugs in the primary study cohort changed –1.7% at 1 year, –1.6% at 2 years, –0.6% at 3 years, 2.4% at 5 years, and 4.1% at 10 years post-launch in the US. When comparing cancer vs noncancer drugs, the researchers observed a substantial increase in post-launch prices among cancer drugs. Overall, estimated trimmed mean drug prices increased by 0.4% per year (1.7% for cancer drugs; –0.8% for noncancer drugs).

Also, trimmed mean drug prices generally decreased after market entry in Germany (−11.1% at 1 year, −28.2% at 2 years, −30.9% at 3 years, −33.4% at 5 years, and −45.2% at 10 years post-launch). The researchers found that post-launch price developments were similar among cancer and noncancer drugs. The estimated trimmed mean drug prices decreased by −5.8% per year (−6.1% for cancer drugs; −5.7% for noncancer drugs).

Similarly, in Switzerland, trimmed mean drug prices generally decreased after market entry (−1.3% at 1 year, −5.6% at 2 years, −9.3% at 3 years, −13.5% at 5 years, and −29.5% at 10 years post-launch). As in Germany, post-launch price developments were similar for cancer and noncancer drugs. Therefore, the estimated trimmed mean drug prices decreased by −3.4% per year (−3.7% for cancer drugs and −3.5% for noncancer drugs).

Lastly, the researchers acknowledged their limitations, one being that their findings may not be generalizable to drugs approved and reimbursed during other periods. Despite their limitations, they suggested developing strategies for lowering drug prices based on their findings.

“When developing solutions on how drug prices can be lowered, which ultimately improves access to patients to new drugs, policymakers should address not only launch prices but also price changes post-launch, especially for cancer drugs,” the authors concluded.

References

1. Laube Y, Serra-Burriel M, Glaus CCEG, Vokinger KN. Launch and postlaunch price developments of new drugs in the US, Germany, and Switzerland. JAMA Health Forum. 2024;5(11):e244461. doi:10.1001/jamahealthforum.2024.4461
2. Tichy EM, Hoffman JM, Tadrous M, et al. National trends in prescription drug expenditures and projections for 2023. Am J Health Syst Pharm. 2023;80(14):899-913. doi:10.1093/ajhp/zxad086