Cleaveland: Prices skyrocket for cancer drugs

Clif Cleaveland

Unrelenting cost increases in many drugs used to treat malignant disorders place unsustainable pressures on pocketbooks of patients and agencies that provide health care.

The drug Gleevec - imatinib mesylate is its chemical name - illustrates the financial challenges often faced by patients for whom the drug is prescribed.

Gleevec is a breakthrough medication that has transformed the management of chronic myeloid leukemia (CML), converting the challenging disease into a chronic condition that can be managed for years, permitting a patient to enjoy a normal life.

An article by Dr. Hagop Kantarjian in the May, 15 2016 American Society of Clinical Oncology Post reviews the pricing of Gleevec since its launch and a recently released generic imatinib. When Gleevec was released in 2001, it cost $26,000 per year. Annual price increases of 10 to 20 percent raised the annual wholesale price to more than $132,000 in 2014. The price rose to more than $145 ,000 this year.

Usually, the release of a generic alternative to a medication will offer a less-costly option. Not so for Gleevec. The generic imatinib, released in February 2016, has a wholesale price tag of $142,000 per year.

In Canada, Gleevec is available for $38,000 per year, while its generic is priced at $8,800 per year.

My own survey in mid-August of retail costs of imatinib at GoodRx.com showed a wide range among Chattanooga pharmacies, from $2,374.95 to $9,479 for a month's supply.

Individuals whose health insurance includes coverage for prescription drugs typically are responsible for a co-payment based on the price that the insurer has negotiated with the drug's manufacturer. Last year, an NBC News report highlighted a patient who was stressed by monthly co-payments of $2,000 for Gleevec.

Rising costs for prescription drugs are a significant factor in the increase in insurance premiums.

The Hatch-Waxman Act of 1984 was designed to promote the development and marketing of less-expensive, generic alternatives to pricey prescription drugs. One provision permits the first firm to bring a generic drug to market to enjoy six months of exclusive rights to market the drug. Various tactics have been employed by pharmaceutical companies to gut the effectiveness of the act. For example, a company may pay manufacturer to delay the release of a generic product. A company also may simply buy out a competitor to control the release of its generic product.

Pharmaceutical manufacturers argue that lofty prices are necessary to cover the high costs of research and development for products such as Gleevec. If that is the case, why must the price be increased substantially every year for years following the initial release? Is this financing research or dividends for investors?

Manufacturers of expensive drugs advertise the availability of discount coupons or free medications for their products. In my experience in clinical practice, qualifying for these reduced prices is cumbersome and often fruitless.

Many medical journals and professional organizations are reluctant to comment on the issue of drug-price inflation. Journals depend upon pharmaceutical advertisements to sustain their publication. Years ago, one leading medical journal with which I was personally acquainted published an article questioning the scientific content of ads relating to prescription drugs. The industry responded by pulling ads from the journal for the following year, causing financial stress.

Medical organizations also may depend upon revenue from drug companies to support their scientific meetings. These meetings play a significant role in introducing new products and highlighting the use of older drugs. Cost of the drugs to the consumer is never mentioned.

Pharmaceutical manufacturers pour millions into lobbying activities both in Washington, D.C., and in state legislatures to block efforts at price control. Drug manufacturers argue that price controls would stifle research.

Voluntary control of runaway prices for prescription drugs is unlikely. All the consumer can do at the moment is gather data to illustrate personal hardship and present this repeatedly to elected representatives until they awaken to the crisis of runaway drug costs and craft legislative solutions.

Contact Clif Cleaveland at ccleaveland@timesfreepress.com.