With the expiration in January of the patent on imatinib (Gleevec, Novartis)—the drug that 15 years ago changed chronic myeloid leukemia (CML) from a death sentence to a treatable illness—patients and insurance companies have the opportunity to realize huge cost savings, new research from the Johns Hopkins Bloomberg School of Public Health suggests.
In an article published in the Journal of the National Cancer Institute, the researchers say that if all CML patients were started upon diagnosis on generic imatinib, the cost of treatment per patient over five years would be nearly $100,000 less than it is now. This means that a health insurer with 100 patients with CML could save $9.1 million over five years.
CML is a relatively rare cancer that starts inside the bone marrow. Approximately 6,000 Americans are diagnosed with the disease each year, and up to 90% survive for five years on drugs such as imatinib. Most CML patients require lifelong, daily medication.
While Gleevec was the first drug to successfully treat CML, two other treatments in the same category (tyrosine kinase inhibitors) have come on the market in recent years: dasatinib (Sprycel, Bristol-Myers Squibb/Otsuka) and nilotinib (Tasigna, Novartis). Generic versions of these drugs will not be available for many years; the branded versions now cost approximately $75,000 each for a year’s supply. In nearly 90% of cases, patients with CML are started on one of these newer drugs, based on the physician’s preference, but research has shown that the overall five-year survival rates for all three drugs are equivalent, the authors say.
Moreover, CML patients tend to switch drugs during the course of treatment if adverse effects occur or if one drug doesn’t appear to be effective, meaning that over the course of five years, approximately 50% of patients will take imatinib for some or all of the time.
The researchers found that if insurers decided to pay only for generic imatinib as the first-line treatment instead of allowing doctors to choose, the savings would exceed $100,000 over five years, assuming that patients remain on imatinib for the entire time. This five-year time point is significant, the authors explain, because it is the period hematologists and oncologists typically use to measure progression-free survival or overall survival from remission in CML patients. With the patent protection on Gleevec expired, the researchers estimate that the per-patient, per-month cost of imatinib will likely drop by 60% to 90% from its current cost of nearly $60,000 a year as manufacturers make and sell the generic version. That could mean the drug could cost less than $6,000 a year for those who stay on it, the researchers say.
In Canada, Gleevec lost patent protection last year, and the price of generic imatinib is now 18% to 26% of the branded drug price. Canada’s national health insurance system has mandated the use of generic imatinib first, which has resulted in large cost savings.
Despite efforts to control costs in the U.S., total prescription drug spending was $374 billion in 2014, up 13% from 2013––the highest annual growth rate since 2001, according to IMS Health.
Source: Johns Hopkins; March 15, 2016.