The cost of oral cancer drugs increased by almost 6% over inflation from 2010 to 2018, leading to increases in out-of-pocket costs for Medicare patients despite reductions in the Part D coverage gap, according to an analysis of formulary and pricing data.
Point-of-sale prices for the 49 oral cancer drugs available before 2018 rose by 40.4% from 2010 to 2018 – an annual increase of 5.8% above the rate of inflation, Stacie B. Dusetzina, PhD, of Vanderbilt University, Nashville, Tenn., and associates reported in JAMA. Another five drugs with data that first became available in 2018 were not included in the cost-increase calculations.
The largest overall increase, 306% (16.2% above inflation per year), belonged to gefitinib (Iressa). Its point-of-sale price rose from $1,960 a month in 2010 to $7,960 in 2018. The award for largest reduction – only two others had a decrease – goes to the only generic available, imatinib. Its monthly cost dropped 44% (–28.1% below inflation per year) from $8,570 in 2016 to $4,822 in 2018, the investigators said (JAMA 2019 May 28;321[20]:2025-7).
Annual out-of-pocket spending for the 13 drugs available for the entire study period increased from $8,794 in 2010 to an expected $10,470 in 2019. Medicare patients’ out-of-pocket costs for those 13 cancer drugs in 2019 are expected to range from $7,220 for lapatinib to $15,472 for lenalidomide, they reported.
“Savings expected through closing the Part D coverage gap or through other policy changes, such as point-of-sale rebates, will be unlikely to offer financial protections to patients needing anticancer drugs. Moreover, because beneficiaries pay a percentage of the drug’s price and have no out-of-pocket spending limits on Part D, even large price decreases may not provide sufficient financial relief to patients requiring long-term anticancer drug use,” Dr. Dusetzina and associates wrote.
The study was supported by the Commonwealth Fund and the Leukemia and Lymphoma Society. The investigators reported receiving grant funding from the study funders.