Lowered Price of Repatha® (evolocumab) Translates to Cost Effectiveness for Range of Heart Conditions in Some High Risk Patients

MedicalResearch.com Interview with:

Gregg C. Fonarow, MD, FACC, FAHA Eliot Corday Professor of Cardiovascular Medicine and Science Director, Ahmanson-UCLA Cardiomyopathy Center Co-Chief of Clinical Cardiology, UCLA Division of Cardiology Co-Director, UCLA Preventative Cardiology Program David Geffen School of Medicine at UCLA Los Angeles, CA, 90095-1679

Dr. Gregg Fonarow

Gregg C. Fonarow, MD, FACC, FAHA
Eliot Corday Professor of Cardiovascular Medicine and Science
Director, Ahmanson-UCLA Cardiomyopathy Center
Co-Chief of Clinical Cardiology, UCLA Division of Cardiology
Co-Director, UCLA Preventative Cardiology Program
David Geffen School of Medicine at UCLA
Los Angeles, CA 

MedicalResearch.com: What is the background for this study?

Response: Last year, Amgen made the PCSK-9 inhibitor evolocumab available at a reduced list price of $5,850 per year This 60% reduction was aimed at improving patient access by lowering patient copays, especially for Medicare beneficiaries.

Additionally, the treatment landscape for PCSK9 inhibitors was further defined in 2018 when the American College of Cardiology/American Heart Association Multisociety Clinical Guideline on the Management of Blood Cholesterol recommended PCSK9 inhibitors for, among other patient populations, patients with very high-risk (VHR) ASCVD whose low-density lipoprotein cholesterol levels remain at 70 mg/dL or more  despite a heart-healthy lifestyle and treatment with standard background therapy.

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Insulin Costs Rise But Mostly Not Paid For Out-of-Pocket by Patients

MedicalResearch.com Interview with:
Dr. Hui ShaoDr. Hui Shao, MBBS, MHA, PhD
CDC

MedicalResearch.com: What is the background for this study? 

Response: 23.1 million people in the U.S. have diagnosed diabetes and 7.4 million regularly use one or more types of insulin. Spending on insulin accounts for a large portion of the costs associated with diabetes. Affordability of insulin has become a public health concern in recent years as high spending on insulin imposes a large financial burden on the national health care system and is associated with poor adherence and health outcomes.

MedicalResearch.com: What are the main findings?

Response: In this study, we analyzed the recent trends in usage and total payments, and patients’ out-of-pocket (OOP) payments for insulin by type in privately insured Americans (MarketScan Claims database) 2003-2017.  We estimated total payment and out-of-pocket payment for a 30-day/yearly supply of different types of insulin and found that, on average, inflation-adjusted annual total payments for insulin increased yearly by around 6% ($153) between 2003 and 2012 and by around 13% ($592) between 2011 and 2017. Similar increase patterns were observed across insulin types.

The major driver for increases in average total payments for a 30-day supply of insulin were explained by increases in payments for existing products and not by changes in the market share of insulin types. In contrast, out-of-pocket payments increased only marginally, suggesting that the increase in insulin spending was not paid directly by the patient.

MedicalResearch.com: What should readers take away from your report?

Response: The average annual total payment increased substantially during the study period, from $1,982 per year in 2003 to $6,360 per year in 2017 (in inflation-adjusted in 2017$). Total payments for insulin have been increasing since 2003 but were at much higher rates after 2011. In contrast, annual out-of-pocket costs increased only marginally from $390 to $451 during the same period, suggesting that the sharp payment increases were not paid out of pocket by the patient. The payment increase occurred across all insulin types, suggesting a lack of inexpensive alternatives in the insulin market. Even for human insulin, the cheapest form of insulin, the average payment for a 30-day supply caught up with insulin analogs in 2017.                                               

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our study population is those with private insurance with the fee for service. Additional research is needed to help determine if similar spending patterns are observed in persons with other types of health insurance, especially those with high-deductible plans and those without health insurance.

Further research in this area could also help us determine the cause of rising insulin costs, and inform decision-making at all levels, which could reduce insulin cost, or slow the consistent increase in cost. 

MedicalResearch.com: Is there anything else you would like to add?

Response: There are no additional comments or disclosures. For more information about how the CDC works to prevent and control diabetes visit https://www.cdc.gov/diabetes/index.html.

 Citation: ADA 2019 abstract

Trend in Total Payment and Out-of-Pocket Payment on a Yearly Supply of Oral Antidiabetic Drug Types among U.S. Adults with Private Health Insurance from 2003 to 2016

HUI SHAOMICHAEL LAXYSTEPHEN R. BENOITYILING J. CHENGEDWARD GREGG and PING ZHANG

 

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The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Primary Care: Brief Training Encourages Discussions of Prescription Drug Costs

MedicalResearch.com Interview with:

Kevin Fiscella, M.D., M.P.H.Dean’s Professor, Family MedicineProfessor, Public Health Sciences and Community HealthUniversity of Rochester  Medical CenterCo-Director, Research DivisionDepartment of Family MedicineRochester, New York 14620

Dr. Fiscella

Kevin Fiscella, M.D., M.P.H.
Dean’s Professor, Family Medicine
Professor, Public Health Sciences and Community Health
University of Rochester  Medical Center
Co-Director, Research Division
Department of Family Medicine
Rochester, New York 14620 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The study was designed to determine whether one hour of training was sufficient to promote conversations between physicians and their patients regarding patient-borne costs of prescriptions.

We found that the training, which promoted a team-based approach involving brief screening and cost-reducing strategies, nearly doubled the number of conversations.

MedicalResearch.com: What should readers take away from your report? 

Response: Brief education on brief screening and practical strategies to lower prescription costs increases office visits discussion of prescription costs and strategies to reduce them.   

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Further questions are whether these effects are sustained and/or whether additional interventions are needed to produce larger and more sustained effects.

No disclosures

Citation:

Ann Intern Med. 2019 May 7;170(9_Supplement):S46-S53. doi: 10.7326/M18-2011.
Addressing Medication Costs During Primary Care Visits: A Before-After Study of Team-Based Training.
Carroll JK1, Farah S2, Fortuna RJ3, Lanigan AM4, Sanders M2, Venci JV5, Fiscella K5. 

https://www.ncbi.nlm.nih.gov/pubmed/31060055

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The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Some Patients Purchasing Over-the-Counter Insulins Due to High Prescription Costs

MedicalResearch.com Interview with:

Jennifer N. Goldstein, MD, MSc Assistant  program Director of Internal Medicine Christiana Care Health System Newark, Delaware

Dr. Goldstein

Jennifer N. Goldstein, MD, MSc
Assistant  program Director of Internal Medicine
Christiana Care Health System
Newark, Delaware

MedicalResearch.com: What is the background for this study?

Response: Human synthetic insulins have been available over-the-counter for nearly a century, and at relatively low cost for around a decade under a Walmart brand name. However, little is known about  the frequency of sale of over-the-counter insulin or the reasons why patients use it.

While prescription insulins (insulin analogues) are considered by many to be easier to use and more predictable than the over-the-counter versions, the cost of these insulins has skyrocketed.

Our study examined the frequency of sale of over-the-counter insulins and whether patients potentially use over-the-counter insulin as a substitute for expensive prescription insulins.

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Price of Existing Biologics Increased When New Drugs Entered Market

MedicalResearch.com Interview with:

Alvaro San-Juan-Rodriguez

Alvaro San-Juan-Rodriguez

Alvaro San-Juan-Rodriguez, PharmD
Pharmacoeconomics, Outcomes and Pharmacoanalytics Research Fellow
Pharmacy and Therapeutics
School of Pharmacy
University of Pittsburgh

MedicalResearch.com: What is the background for this study?

Response: Before 2009, etanercept (Enbrel®), infliximab (Remicade®), and adalimumab (Humira®) were the only tumor necrosis factor (TNF) inhibitors approved by the FDA for rheumatoid arthritis. Subsequently, 3 therapies gained FDA approval: subcutaneous golimumab (Simponi®) in April 2009, certolizumab pegol (Cimzia®) in May 2009, and intravenous golimumab (Simponi Aria®) in July 2013. All 6 agents are brand-name drugs.

Our study aimed to evaluate how the prices of existing TNF inhibitors (Enbrel®, Remicade® and Humira®) changed in response to the market entry of new TNF inhibitors.  Continue reading

WHO: Profits Outweigh R&D Costs of New Cancer Drugs

MedicalResearch.com Interview with:

Kiu Tay-Teo, PhD World Health Organization Geneva, Switzerland

Dr. Kiu Tay-Teo

Kiu Tay-Teo, PhD
World Health Organization
Geneva, Switzerland

MedicalResearch.com: What are the main findings?

Response: High costs and high risks of R&D for drugs have been presented to justify high drug prices, especially for cancer drugs. However, it is unclear whether prices are in fact justifiable compared to the overall return on R&D investment.

In this paper, we systematically compared incomes from the sales of cancer drugs with the R&D costs. We quantified the incomes generated from the sales of 99 cancer drugs approved by FDA from 1989–2017. This was based on sales figures reported in the originator companies’ annual financial reports, and where necessary, estimates deduced from the reported figures. The sales incomes were net of rebates and discounts, but without accounting for expenses and taxes. For the R&D costs of bringing one new cancer drug to the market, the literature reported a typical costs of between $219 million and $2.9 billion, after accounting for the costs of failed products that were investigated but not marketed and the opportunity costs. For the main analysis, we used a median cost of $794 million, as reported in the literature. To be clear, this analysis did not estimate profit return because we do not have information about the costs and year-to-year variations in costs (i.e. expenses and taxes) specific to cancer drugs.

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Specialty Drugs and Increase Price of Brand Names Raise Health Care Costs

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy

Dr. Hernandez

Inmaculada Hernandez, PharmD, PhD
Assistant Professor of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The objective of our study was to answer a research question of high policy relevance: to what extent are rising drug costs due to inflation in the prices of existing products versus the market entry of new, more expensive drugs.

We found that rising prices of brand-name drugs are largely driven by manufacturers increasing prices of medications that are already in the market rather than to the entry of new products.

In contrast, increases in costs of specialty and generic drugs were driven by the entry of new drugs.

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How Much Do Clinical Trials For New Medications Really Cost?

MedicalResearch.com Interview with:

Thomas J Moore Senior Scientist Institute for Safe Medication Practices Lecturer, Department of Epidemiology and Biostatistics The George Washington University Milken Institute of Public Health Alexandria, VA 22314

Thomas J Moore

Thomas J Moore AB
Senior Scientist Institute for Safe Medication Practices
Lecturer, Department of Epidemiology and Biostatistics
The George Washington University
Milken Institute of Public Health
Alexandria, VA 22314

MedicalResearch.com: What is the background for this study? What are the main findings?

  • The study provides realistic cost estimates of pivotal clinical trials that establish drug benefits to support FDA approval of 59 new drugs released for marketing in 2015-2016.
  • The median estimated cost was just $19 million, with half of the 138 trials studied clustered between $12 million and $33 million.
  • The highest cost trials–with estimates up to $345 million–were for new drugs that were similar to drugs already available and already proven in treating serious illnesses. 

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Costs of Older Cancer Drugs Have Risen More Than New Medications

MedicalResearch.com Interview with: Dr. Sham Mailankody, MBBS

Dr. Sham Mailankody

MedicalResearch.com Interview with:
Dr. Sham Mailankody, MBBS
Memorial Sloan Kettering Cancer Center

MedicalResearch.com: 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.

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Autoimmune Specialty Drug Spending Doubles, Accounting for 10 Percent of Drug Expenses

MedicalResearch.com Interview with:

Kevin Bowen MD MBA Senior Health Outcomes Researcher Prime Therapeutics LLC 1305 Corporate Center Drive Eagan, MN 55121

Dr. Kevin Bowen

Kevin Bowen MD MBA
Senior Health Outcomes Researcher
Prime Therapeutics LLC
1305 Corporate Center Drive
Eagan, MN 55121

MedicalResearch.com: What is the background for this study? What are the main findings?

• Autoimmune specialty drugs now account for about one of every 10 dollars of combined drug expense through the medical and pharmacy benefits in a commercially insured population.
• The autoimmune drug class is one of the fastest growing, with this study finding a doubling in autoimmune drug expenditures and a 38 percent increase in utilization, in the most recent four years.
• Integrated analysis of medical and pharmacy claims is essential for this category of drugs because more than 25 percent of autoimmune specialty drug use is paid through the medical benefit and medical claims diagnosis coding provides a means of determining what conditions were treated with drugs covered by pharmacy claims.
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