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New Cancer Cocktails Expected to Test Price Ceilings

Immunotherapies are costly but offer long-lasting responses

New cancer drug cocktails set to reach the market in the next few years will test the limits of premium pricing for life-saving medications, according to a Reuters report.

The growing reluctance of governments and private insurers to fund very expensive drugs points to a showdown as manufacturers mix and match therapies that harness the immune system to fight tumors. Several companies acknowledge that discounts will be needed when drugs costing more than $100,000 each are combined.

Dozens of new cancer combinations will be launched over the next few years, with ones for lung cancer, melanoma, and other solid tumors taking off after 2018, drug company pipelines indicate.

Pricey immunotherapies offering long-lasting responses are already starting to change clinical practice as doctors use so-called checkpoint inhibitors, such as pembrolizumab (Keytruda, Merck) and nivolumab (Opdivo, Bristol-Myers Squibb), in melanoma and lung cancer.

But the real promise, Reuters says, lies in combining treatments, either by using two checkpoint medications together or by adding a different type of drug. Both approaches will drive up prices. Giving every U.S. patient whose cancer has metastasized nivolimumab plus another Bristol-Myers Squibb immunotherapy, ipilimumab (Yervoy), for example, would cost $174 billion, based on a combined list price of $295,000 for just under 1 year’s treatment.

The strains on health care budgets are clear. Worldwide cancer drug spending increased 10% in 2014 to $100 billion, up from $75 billion 5 years earlier, with oncology now accounting for 11.3% of total drug spending in the U.S., according to IMS Health.

Most of the current buzz around checkpoint inhibitors centers on drugs blocking a protein known as programmed death receptor-1 (PDR-1), which tumors use to evade the body’s natural defenses, plus another protein called CTLA-4, Reuters says. But an alphabet soup of second-generation therapies is waiting in the wings, with names like OX40, LAG3, and TIM3, pointing to many new potential combinations.

It all means increasingly difficult choices for health care providers, under pressure from patients and their families to provide access to modern treatments.

IMS data show that monthly cancer therapy costs have increased by 39% over the past 10 years in inflation-adjusted terms, similar to the 42% increase in overall response rates. But there has also been a 45% increase in the time that patients are on therapy, pushing up costs further, Reuters points out.

Price is a growing issue for doctors in the U.S., where out-of-pocket costs can threaten to bankrupt some patients, as well as for pharmacy benefit managers, who negotiate drug prices for health plan members.

Source: Reuters; August 3, 2015.



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