Costs of Older Cancer Drugs Have Risen More Than New Medications Interview with: Dr. Sham Mailankody, MBBS

Dr. Sham Mailankody Interview with:
Dr. Sham Mailankody, MBBS
Memorial Sloan Kettering Cancer Center What is the background for this study?

Response: The high price of older drugs has been increasingly criticized in part because of recent dramatic price hikes. There are some well known examples like pyrimethamine and more recently EpiPen. Whether and to what degree examples like pyrimethamine represent a common problem or exceptional cases remains unknown. Using Medicare data available for Part B, we sought to analyze the change in average sales price of cancer drugs between January 2010 and January 2015, and whether older drugs were more likely to undergo price increases than newer drugs. What are the main findings?

Response: 86 cancer drugs reported average sales price in both January 2010 and January 2015. Adjusting for inflation, 55 (64%) drugs increased in price over this time period. Eleven drugs (12.7%) underwent price increases of more than 100%. Older drugs (FDA approved prior to December 1992) increased in price more than newer drugs (approved after December 1992): median increase of 22.7%vs 6.2%. What should readers take away from your report?

Response: The high price of cancer drugs has increasingly drawn criticism from leading academics, and threatens health care budgets. We have previously shown that new drug pricing bear no relationship to novelty or efficacy. Our analysis shows that older drugs have undergone larger price increases than newer drugs, and some drugs have undergone dramatic price increases. Raising the price of older drugs seems particularly objectionable when one considers that the outlay for research and development occurred long ago, and has almost certainly already been recouped. What recommendations do you have for future research as a result of this study?

Response: Future research must explore reasons for price hikes for older cancer drugs. Particularly the impact of generic approvals and number of generic manufacturers on the price of drugs is an important topic. Is there anything else you would like to add?

Response: The key issue is potential solutions for high drug costs. There are several proposed solutions some of which I have outlined below.

1. Faster generic approvals and ensuring multiple generic manufacturers. It is well recognized that the introduction of generic alternatives can help lower drug prices. Prior research from other groups has also shown that the number of generic manufacturers for a given drug is also an important factor in drug costs. Oncologic drugs that have few or no generic manufacturers are likely more susceptible for price increases. The US Food and Drug Administration (FDA) has focused on faster generic approvals (especially in the last couple of years) while ensuring safety and efficacy but more could be done. There are other issues with timely availability of generic drugs and these are reviewed here-

2. Drug price transparency- Drug pricing in the United States in largely non-transparent and the rationale for price hikes are often unclear. Several states are discussing legislation to ensure pricing transparency and this would be an important step in rational drug pricing.

3. Pharmaceutical companies must take leadership in ensuring affordable, sustainable drug prices for all patients. See for instance the recent statement on drug pricing from Allergan Pharmaceuticals (

4. The Center for Medicare and Medicaid Services (CMS) cannot negotiate drug prices; this is quite different from other parts of world for e.g. Canada, UK, Australia etc. CMS must be allowed to negotiate drug prices. Thank you for your contribution to the community.

The Rising Price of Cancer Drugs—A New Old Problem?
Vinay Prasad MD, MPH, Ruibin Wang MS, Salma H Afifi PharmD, Sham Mailankody MBBS
Vinay Prasad, MD,et al

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on October 12, 2016 by Marie Benz MD FAAD