The Formulary Files

Costs of biologics for inflammatory conditions vary


Krishna Rutvij Patel, PharmD

We have all heard those ominous numbers forecasting that half of all drug costs will be from specialty products in the near future. As is evident from the graph below, the future is not far off because, according to Avalere, adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) were among the 10 drugs with highest revenue in the past year, even though Humira and Enbrel were only among the 100 most prescribed drugs and Remicade didn’t even make that list.

Formulary decision makers beware: Expensive specialty drugs are here to stay. So, what will you do to control costs? Further, it’s not just about the drug cost. When looking at the whole package, consider administration cost for these biologics as well as tolerability issues that warrant additional treatment.

Evidera and Amgen jointly published a study that sought to estimate the annual cost of eight biologics per patient per inflammatory disease. This retrospective, observational analysis of the Medco pharmacy benefit management database involved claims between Jan. 1, 2008 and Aug. 31, 2011. The 8,306 privately insured patients included in this study were ages 18–63, were continuously enrolled for at least 180 days before and 360 days after receiving the first biologic, and had at least one claim for Orencia, Humira, Cimzia, Enbrel, Simponi, Remicade, Rituxan, or Stelara indicated for rheumatoid arthritis, psoriasis, psoriatic arthritis, or ankylosing spondylitis. Factors used to calculate total annual biologic cost included total dose of biologic, total number of administrations, October 2013 wholesale acquisition cost, and injection/infusion administration fees. This total annual biologic cost was divided by number of patients treated with the biologic to calculate the mean annual cost per treated patient.

Across all indications, mean annual total cost per patient was $23,886 for Enbrel, $24,091 for Remicade, and $24,528 for Humira, the three most-prescribed biologics for these indications. Although these numbers may not stand true across all payers, the study design helps formulary decision makers to determine their own costs for these drugs. Limitations of this study include the fact that it was retrospective, it did not include government-sponsored health insurance, and that the number of patients treated with each drug varied greatly.

Annual cost of biologics for inflammatory diseases

Annual cost of biologics for inflammatory diseases

Source: Wu N, Lee Y, Shah N, Harrison DJ. Costs of biologics per treated patient across immune-mediated inflammatory disease indications in a pharmacy benefit management setting: a retrospective cohort study. Clin Ther. 2014;Epub ahead of print.