NSCLC Drugs Raised Prices Despite Evidence of Price Competition

Despite evidence of price competition, brand-name medications for the treatment of non–small lung cancer (NSCLC) increased prices from 2015 to 2020, raising concerns about the affordability of these drugs as well as the need for drug pricing reform, according to a study published in JAMA Network Open.

Researchers from the Mayo Clinic conducted a cross-sectional study of 17 brand-name medications for NSCLC to assess price changes in the United States.

“In capitalistic systems, increased competition is expected to lower prices; however, this has not been the case with competition among brand-name drugs within the same class in oncology,” they explained.

The paper reviewed therapies across multiple drug classes:

• Immune checkpoint inhibitors (ICIs): pembrolizumab, nivolumab, atezolizumab, and durvalumab
• Epidermal growth factor receptor (EGFR) inhibitors: gefitinib, afatinib, erlotinib, osimertinib, and dacomitinib
• Anaplastic lymphoma kinase (ALK) inhibitors: crizotinib, ceritinib, alectinib, brigatinib, and lorlatinib
• BRAF inhibitors: dabrafenib and vemurafenib
• MEK inhibitor: trametinib

Over 5 years, the median compound annual growth rates (CAGRs) were 1.81% (1.29%-2.15%) for the ICIs, 2.56% (2.38%-5.26%) for the EGFR inhibitors, 2.46% (1.75%-4.66%) for the ALK and ROS1 inhibitors, and 3.06% (0%-3.06%) for BRAF and MEK inhibitors. The annual growth rate of the consumer price index for prescription drugs during that time was only 2.10%, which only the ICIs were below. All classes outpaced the average yearly inflation rate (1.75%).

The authors conjectured that the reason the ICIs had a lower CAGR may be because of “an increasing number of immunotherapy drugs in the pipeline and an expanding number of indications.”

Only 1 drug, erlotinib, had a price decrease, which occurred between 2019 and 2020 when a generic competitor entered the market. However, this is not a normal phenomenon, and the authors wrote that “introduction of generics does not substantially change the cost of cancer therapy.”

The positive correlation between high list prices among different drugs within the same class across 5 therapeutic classes “suggest that there was little price competition among the manufacturers of these products.”

Instead of oncology drug prices decreased over time after market entry, most anticancer agents have a list price that increases, the authors noted.

The study used average sales price and wholesale acquisition cost, which may not reflect true prices paid since they do not include discount negotiations or rebates, the authors noted.

“The lock-step price increases of brand-name medications without evidence of price competition raise concern about the affordability of promising oncology drugs,” the authors wrote in conclusion. “Academic, industry, and government partnerships should be developed to address the high costs of prescription oncology drugs, which may soon be unaffordable for most patients if the trends discovered in the present study continue.”