Despite New Launches, No Price Drops Seen Among Brand-Name NSCLC Drugs

Between 2015 and 2020, prices of brand-name medications for treatment of metastatic non–small cell lung cancer (NSCLC) increased without evidence of price competition, according to research published today in JAMA Network Open.

The findings raise concern about the affordability of promising oncology drugs and suggest the need for drug pricing reform, authors wrote.

Previous studies have shown that the introduction of new anticancer agents in the US market did not lower prices among same-class brand-name oncology drugs, contrary to what one might expect in a capitalist system. Oncology drug prices also function as a determinant of health disparities.

As numerous new drugs have also been approved for the treatment of NSCLC in recent years, researchers set out to study price competition for this cancer subtype using information from the Micromedex Red Book and Medi-Span Price Rx databases. Data on immune checkpoint inhibitors (ICIs; immunotherapy), epidermal growth factor receptor (EGFR) inhibitors, anaplastic lymphoma kinase (ALK) inhibitors, ROS1 inhibitors, BRAF inhibitors, and MEK inhibitors were included in the analysis.

Researchers assessed average wholesale prices (AWPs) for oral agents and wholesale acquisition cost (WAC) for intravenous agents that were introduced between 2015 and 2020. All medications included in the analysis were brand name and available for purchase before January 1, 2019, “to better characterize the pricing trends of the drugs that have been in the market for more than 1 year.”

The AWPs and WAC used did not include contracts, rebates, or other discounts. Of the 17 drugs included in the study, 4 were ICIs, 5 were EGFR inhibitors, 5 were ALK inhibitors, 2 were BRAF inhibitors, and 1 was a MEK inhibitor.

Analyses revealed:

• For all drug classes, the Pearson correlation coefficient approached 1.0, indicating an increase in drug list prices despite within-class drug competition.
• The median Pearson correlation coefficient values were 0.964 (range, 0.951-0.994) for ICIs, 0.898 (range, 0.665-0.950) for EGFR inhibitors, 0.999 (range, 0.982-0.999) for ALK inhibitors, and 0.999 for BRAF and MEK inhibitors.
• The median compounded annual growth rates for most drug costs were higher than the annual inflation rate and consumer price index for prescription drugs: 1.81% (range, 1.29%-2.13%) for ICIs, 2.56% (range, 2.38%-5.26%) for EGFR inhibitors, 2.46% (range, 1.75%-4.66%) for ALK and ROS1 inhibitors, and 3.06% (range, 0%-3.06%) for BRAF and MEK inhibitors.

Overall, findings indicated little price competition among the manufacturers of these products, consistent with prior research showing “little difference exists in the median wholesale price of novel drugs and next-in-class drugs.”

Only 1 instance of a price decrease was identified, which occurred alongside the introduction of a generic alternative. Typically, the introduction of generics does not affect the cost of cancer therapy, however.

Furthermore, although the introduction of generics can involve the promise of lower prices, generic competition is often delayed, and manufacturers can extend patents or develop more convenient dosage forms to maintain their market share.

Increased drug prices correlate with higher patient out-of-pocket costs, which in turn can create financial toxicity. This could lead to increased symptom burden, worse quality of life, and increased cancer mortality among patients.

Discount negotiations or rebates were not reflected in the public WAC and AWPs, but “rebates, list prices, and net prices have been increasing for brand-name medications, and rebate growth has been shown to be positively correlated with list price growth, thereby impacting costs for patients,” the authors wrote.

Despite more same-class drugs brought to market, data showed that prices did not decrease for these NSCLC treatments, and the median change in drug list prices actually outpaced that of other prescription drugs and the average inflation rate.

“This may not be the expected outcome in a liberal economy, in which competition should lead to lower prices for consumers,” researchers said, adding that the lock-step price increases of brand-name medications identified, absent evidence of price competition, raise concern about promising oncology drugs’ affordability.

Partnerships between academia, industry, and government can work to address the high cost of prescription oncology drugs, “which may soon be unaffordable for most patients if the trends discovered in the present study continue,” they concluded.

Reference

Desai A, Scheckel C, Jensen CJ, et al. Trends in prices of drugs used to treat metastatic non-small cell lung cancer in the US from 2015 to 2020. JAMA Netw Open. Published online January 25, 2022. doi:10.1001/jamanetworkopen.2021.44923