The Cost of Cancer: New Checkpoint Inhibitors Do the Job, But at a Steep Price

Annual price tag can top $250,000

Checkpoint inhibitors––newer cancer drugs that enlist the body’s immune system––are improving the odds of survival, but competition among them is not reining in prices that can top $250,000 a year, according to a Reuters report.

Checkpoint inhibitors work by releasing a molecular brake, allowing the immune system to recognize and attack cancer cells the same way it fights infections caused by bacteria or viruses. For cancers such as melanoma, the treatments can mean long-term survival for approximately 20% of patients, Reuters estimates.

Ipilimumab (Yervoy, Bristol-Myers Squibb), approved in 2011, targets cytotoxic T-lymphocyte–associated protein 4 (CTLA-4). Other immunotherapies, including nivolumab (Opdivo, Bristol-Myers Squibb), pembrolizumab (Keytruda, Merck), atezolizumab (Tecentriq, Roche), and avelumab (Bavencio, Pfizer), involve the programmed cell-death 1 (PD-1) protein.

Current checkpoint inhibitors each have a list price of nearly $150,000 a year. A combination of ipilimumab and nivolumab––approved for patients with advanced or inoperable melanoma––carries a price tag of $256,000 a year for patients who respond to the treatment.

The global market for cancer immunotherapies is expected to grow more than fourfold to $75.8 billion by 2022 from $16.9 billion in 2015, according to the research firm GlobalData.

“For cancer drugs in general ... it is hard for us to drive down cost,” Steve Miller, chief medical officer at Express Scripts, told Reuters. “You don’t want to be in the position of being told to use the second-best cancer drug for your child.”

U.S. lawmakers have been struggling with how to restrain rising prescription drug costs. They have talked about solutions ranging from more price negotiation to faster approval of new drugs, with the aim of spurring increased competition among drug makers.

“Competition is key to lowering drug prices,” President Trump told pharmaceutical executives at an Oval Office meeting in January.

But that is not happening with the checkpoint inhibitors, according to Reuters.

“Cancer drugs don’t compete on price,” said Dr. Aaron Kesselheim, a researcher at Harvard Medical School and author of several studies of drug pricing. “Drug companies have market exclusivity, and we require payers to cover cancer drugs. Medicare has six protected classes, including cancer.”

Trump met recently with Representatives Elijah Cummings(D-Maryland) and Peter Welch (D-Vermont) to discuss draft legislation allowing the government to negotiate Medicare drug prices––but the bill preserves the six protected classes.

“All of the immunotherapies have similar price points,” Miller said. “When you stack therapies, it means more expense for patients and [health] plan sponsors.”

Source: Reuters; April 3, 2017.