ASCO '15: A Review of Cancer Rx Use and Costs

May 27, 2015

Express Scripts summarizes cancer pharmacy data and forecasts in advance of the 2015 American Society of Clinical Oncology Annual Meeting in Chicago.

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  • Cancer

Researchers and clinicians will gather at the American Society of Clinical Oncology (ASCO) annual meeting later this week to discuss the latest advances in treating patients with cancer, and will continue the important conversation about improving the accessibility and affordability of these breakthrough therapies.

Following is a review of cancer medication spending in the pharmacy benefit, and a look at the forecast for this therapy class.

Cancer Contributes to High Annual Rx Costs

Top 10 Conditions Among Patients with more than $100000 Rx Spend in 2014 

Cancer medications, along with hepatitis C and compounded medications make up two-thirds of the medication costs among patients whose total 2014 annual medication spending reached or exceeded $100,000 under the pharmacy benefit.

Notable trends among patients in this population:

  • 32% were treated for cancer.
  • 57% were Baby Boomers, half of whom were being treated for cancer.
  • 55% of men in this category were using a cancer medication, compared to 45% of women.
  • Multiple comorbidities were especially prevalent among patients with cancer in this category, the most common being high blood pressure, high blood cholesterol and depression. 
  • 28% of patients in this patient group who were taking a cancer medication also took an antidepressant.

Trends in Cancer Medication Spending

Components of Trend Specialty Cancer 2014 

As noted in the 2014 Express Scripts Drug Trend Report, cancer medications were the third-largest contributor to 2014 specialty medication spending in the pharmacy benefit. While slightly slower than previous years, spending on cancer medications increased 20.7% in 2014, the result of an 8.9% increase in use and an 11.7% increase in unit cost.

Top Cancer Drugs by Market Share 

Unit cost increases for Gleevec® (imatinib), which captured 12.5% of market share in the pharmacy benefit, and Revlimid® (lenalidomide), which captured 10.8% of market share in the pharmacy benefit, were prime contributors. Temozolomide, a generic for Temodar® which became available in 2013, continued to capture market share. Generics for Xeloda® (capecitabine), which became available in 2014, were the fourth most commonly used cancer medications last year.

Yet, despite the availability of generic oral cancer therapies, which helps to ease the cost burden of these medications, nonadherence to oral cancer medications remains high: 38.2% of patients were nonadherent with their therapy in 2014.

Forecast

Express Scripts expects cancer medications will maintain their lead position as a major contributor to drug spending in the pharmacy benefit, due to the availability of new medications and increased survival requiring long-term use of expensive and complex treatment.

The FDA approved nine new branded cancer therapies in 2014, and is on track to approve 12 in 2015. Four new cancer therapies – Ibrance® (palbociclib) for breast cancer, Lenvima™ (lenvatinib) for thyroid cancer, Farydak® (panobinostat) for multiple myeloma and Unituxin™ (dinutuximab) for Neuroblastoma – have already been approved this year.

Offering some relief is the expected availability of a generic for Gleevec in 2016, and the potential availability of biosimilars. If brought to market, the 11 biosimilars seeking FDA approval could bring savings of more than $250 billion to the U.S. healthcare system over the next 10 years. Five of those 11 medications are used in the treatment of cancer:

  • Avastin® (bevacizumab)
  • Epogen® (epoetin alfa)
  • Herceptin® (trastuzumab)
  • Neulasta® (pegfilgrastim)
  • Neupogen® (filgrastim)

Zarxio™, the biosimilar for Neupogen and the first-ever biosimilar approved for use in the U.S. by the FDA in February 2014, is estimated to deliver $5.7 billion in savings over the next 10 years once it reaches the marketplace, possibly as early as this summer.

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Lab Staff
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