The nonprofit organization, Value in Cancer Care Consortium, recently completed research suggesting a popular cancer drug that typically costs $148,000 per year for patients may work just as effectively in smaller doses, and could cut the drug’s prices down to about $50,000. However, just as this research was made public, the Washington Post reported that the drug’s manufacturers had received approval for a new pricing strategy that changed the pill’s dosing and effectively tripled the price of the drug.
The drug, brand name Imbruvica (ibrutinib), is currently available in 140mg capsules. Patients may take doses from 140mg per day up to 560mg per day, depending on their particular cancer and situation. Last year, a group of doctors presented results from a trial showing promising results that smaller doses of Imbruvica could work just as effectively as a larger dose. They found that starting patients out on three pills a day, and working them down to one or two, worked as well as taking three pills a day —dramatically cutting patient costs, and the extremely unpleasant side effects.
Currently, each 140mg pill costs about $133. However, as the doctor consortium began preparing to perform more research and patient trials, the companies which sell the drug, Janssen and Pharmacyclics, made an announcement. They received approval to sell the drug in four different tablets of varying strengths—the standard 140mg, plus 280mg, 420mg, and 560mg. All four dosages will be the same price, about $400 each, even the 140mg tablet. The current $133 tablet is set to be phased out within three months.
As you can see, this new dosage and pricing plan effectively erases the opportunity to offer lower costs with lower dosages. If a patient was able to drop down their dosage to one pill per day, they will now pay $400 per pill instead of the current $133 per pill. Janssen and Pharmacyclics explained the change by stating that their dosages are “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 pointed out that patients who take 560mg of Imbruvica will save money with the new pricing.
Not everyone agrees. Oncologist Mark Ratain of the University of Chicago Medicine bluntly told the Post, “That got us kind of pissed off.” Ratain and his colleagues explained in the April Cancer Letter that the new dosage schedule will make it difficult for doctors to adjust their patients’ dosages by simply telling them to take a different number of pills each day, as they do now with the 140mg pills. To change a patient’s dosage from, say, 420mg per day to 140mg per day would now require paperwork, a new prescription, and forcing patients to return their unused pills—a long and unnecessary process.
The group has called upon the Food & Drug Administration to investigate the pharmaceutical company’s new strategy, as they believe it creates a barrier to optimal prescribing for patients. In the April Cancer Letter, 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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