Research conducted by the nonprofit Value in Cancer Care Consortium recently suggested that a popular cancer drug that typically costs $148,000 per year for patients could work just as effectively in smaller doses, potentially cutting costs down to about $50,000 annually. However, the Washington Post reported that the manufacturer has gotten approval for a new pricing strategy that will change pill dosages and essentially triple the price of the drug.
The drug, brand name Imbruvica (ibrutinib), typically comes in 140mg capsules. Patients can take doses from 140mg a day all the way up to 560mg a day, depending upon their cancer and individual situation. Last year, doctors presented results from a trial showing promise that smaller doses could work just as well as a larger dose—typically starting a patient out on three pills a day and working down to one or two. This could dramatically cut patient costs, as well as unpleasant medication side effects.
Each 140mg pill costs about $133. However, as the consortium was gearing up to perform more research and patient trials, Imbruvica’s manufacturer, Janssen and Pharmacyclics, made an announcement. They had gotten approval to sell the drug in four different tablets of varying strengths—140mg, 280mg, 420mg, and 560mg. And, all of these dosages will be the same price, about $400 each, including the lowest dose 140mg tablet. The $133 tablet will be phased out within three months.
This new pricing plan effectively voids the opportunity to lower patient costs with lower dosages. If a patient is able to drop down to just the one pill per day, they would now be paying $400 a pill instead of the current $133 a pill. Janssen and Pharmacyclics explained the change by saying the new line-up is “a new innovation to provide patients with a convenient one pill, once-a-day dosing regimen and improved packaging, with the intent to improve adherence to this important therapy.” They noted that those taking 560mg a day will save money with the new pricing.
Oncologist Mark Ratain of the University of Chicago Medicine disagrees. He told the Post, bluntly, “That got us kind of pissed off.” In the April Cancer Letter, Ratain and his colleagues pointed out that the new dosage schedule will make it difficult for doctors to adjust patient dosages by simply telling them to take a different number of pills each day. Changing a patient’s dose from 420mg per day down to 140mg per day would now require paperwork, filling a new prescription, and having patients return their unused pills—a long and unnecessary process.
In their letter, they called upon the Food & Drug Administration to look into the issue, as they believe the new pricing strategy will create a barrier to optimal prescribing for patients. They wrote, “We further urge the FDA to recognize that the combination of the high price per pill and the flat pricing scheme are specific impediments to safe administration, and that ignoring the marketing approach for ibrutinib is antithetical to fostering optimally safe dosing and administration.”
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