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de Silva NL, Dissanayake H, Kalra S, Meeran K, Somasundaram NP, Jayasena CN. Global Barriers to Accessing Off-Patent Endocrine Therapies: A Renaissance of the Orphan Disease? J Clin Endocrinol Metab 2024; 109:e1379-e1388. [PMID: 37846800 PMCID: PMC11031238 DOI: 10.1210/clinem/dgad610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023]
Abstract
CONTEXT Clinical endocrinology encompasses many diseases requiring long-term drug therapy. Prohibitive pricing of some endocrine drugs classified as essential by the World Health Organization has created suboptimal care of patients with endocrine disorders. EVIDENCE ACQUISITION This review is based on evidence obtained from several databases and search engines including PubMed, Google, and Google Scholar; reference searches; manual searching for web pages of international regulatory bodies; and the authors' experience from different healthcare settings. EVIDENCE SYNTHESIS After the expiry of a patent, generic versions with the opportunity for increased availability and a price reduction are expected. There are access barriers worldwide for many off-patent endocrine drugs. The high price is the main issue for several medicines including insulin, hydrocortisone, testosterone, and gonadotropins. This is caused by several factors including the market monopoly due to the lack of registered generics or suppliers limiting the benefit of competition and a complex supply chain. Additionally, the lack of some medicines has been concerning due to market factors such as the relatively small number of patients, making it less attractive for the manufacturers. Commissioning of nonprofit manufacturers and state manufacturing as well as strict price control measures could alleviate this situation. CONCLUSION Lack of availability and disproportionate price inflation affecting essential off-patent endocrine therapies is common due to several interrelated factors. Global collaboration among healthcare organizations with the support of policymaking bodies might be needed to mitigate this.
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Affiliation(s)
- Nipun Lakshitha de Silva
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana 10390, Sri Lanka
| | - Harsha Dissanayake
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana 132001, India
- University Centre for Research and Development, Chandigarh University, Mohali 140413, India
| | - Karim Meeran
- Department of Metabolism, Digestion and Reproduction, Imperial College, W12 0NN, London, UK
| | | | - Channa N Jayasena
- Department of Metabolism, Digestion and Reproduction, Imperial College, W12 0NN, London, UK
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Garrison LP, Jiao B, Dabbous O. Value-Based Pricing for Patent-Protected Medicines Over the Product Life Cycle: Pricing Anomalies in the "Age of Cures" and Their Implications for Dynamic Efficiency. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:336-343. [PMID: 36336584 DOI: 10.1016/j.jval.2022.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/31/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Conventional cost-effectiveness analysis (CEA) for the value-based pricing of new medicines largely ignores the implications of limited market exclusivity (ie, patent-protection periods plus any exclusivity granted by regulators). This paper explores the implications of this methodological shortcoming, which produces several pricing anomalies with potentially unintended effects on research and development (R&D) incentives. METHODS We illustrate these implications by comparing 4 stylized examples of increasing complexity, from short-term cures for acute conditions to long-term cures for rare, health-catastrophic conditions. RESULTS (1) Conventional-CEA will project a different result than an adjusted CEA that considers generic or biosimilar entry; (2) free and flexible pricing of long-term treatments (eg, statins for hypercholesterolemia) or repeated-dose cures (eg, insulin for type 1 diabetes) for chronic conditions will likely result in predictable price increases at the end of the exclusivity period that may be perceived as unjustified or unsupported; and (3) one-time administration "cures" (eg, gene therapy for spinal muscular atrophy) have the potential to allocate a large share of the social surplus to the manufacturer over the product lifetime, which may or may not be dynamically efficient per se, but may also inadvertently disadvantage the development of valuable long-term treatments or repeated-dose cures for chronic conditions. CONCLUSIONS We highlight the need for additional research on long-term solutions to these issues that would aim to promote dynamically efficient global R&D. More work is needed on the following: (1) relationships between social surplus allocation and the amount and composition of global R&D, as we may be as likely to be encouraging excessive R&D in some areas as to be undersupplying it in others; and (2) relating the size of the surplus reward to R&D cost and, thus, the return on investment.
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Affiliation(s)
| | | | - Omar Dabbous
- Novartis Gene Therapies, Inc., Bannockburn, IL, USA
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Thomas CM, Shae W, Koestler D, DeFor T, Bahr N, Alpern JD. Antifungal drug price increases in the United States, 2000-2019. Mycoses 2022; 65:859-865. [PMID: 35722703 PMCID: PMC9378588 DOI: 10.1111/myc.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Antifungal drugs treat a variety of conditions, ranging from localised dermatologic disease to life-threatening systemic infections. Some common antifungal drugs experienced large price increases in recent years, however, factors contributing to these price increases are poorly understood. We sought to examine trends in antifungal drug prices and determine underlying drivers of price changes. METHODS Antifungal drug products in the United States were identified using the Food and Drug Administration (FDA) Label database. For each product, we determined the wholesale acquisition cost per unit over time between 2000 and 2019, adjusting for inflation, and examined variables that could impact price: route of administration, number of FDA indications, the quantity of professional guideline recommendations, use for prophylaxis, number of FDA-approved manufacturers, and whether it was compounded. Price trajectories were clustered into four groups: (1) stable, 2) moderate, (3) high, and (4) extreme price increases. RESULTS Of 139 identified drug products, one outlier was removed due to exorbitant price increases. Cluster 1 (n = 31) demonstrated the most stable prices with a 25% mean price increase. Clusters 2 (n = 97), 3 (n = 7), and 4 (n = 3) demonstrated moderate, high, and extreme price increases with 52%, 318%, and 900% mean price increases, respectively. Atypical routes of administration and compounding were over-represented in clusters 3 and 4. There was no correlation between the number of manufacturers and price changes. CONCLUSIONS Antifungal drugs exhibited large, inflation-adjusted price increases. Atypical routes of administration and compounding were over-represented within clusters exhibiting extraordinary price increases. Our data support policies aiming to curb large price increases for medically important drugs.
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Affiliation(s)
- Christine M. Thomas
- Division of Infectious Diseases and International Medicine, Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Whitney Shae
- Department of Biostatistics & Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Devin Koestler
- Department of Biostatistics & Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | | | - Nathan C. Bahr
- Division of Infectious Diseases, Department of MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Jonathan D. Alpern
- Division of Infectious Diseases and International Medicine, Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
- HealthPartners InstituteBloomingtonMinnesotaUSA
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Characteristics of State Legislation Addressing Prescription Drug Price Increases in the United States, 2020. J Gen Intern Med 2022; 37:1554-1557. [PMID: 34047918 PMCID: PMC9086023 DOI: 10.1007/s11606-021-06838-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022]
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Lindrose AR, Fraser JA, Hickey PW, Mitre E. Costs and Prescribing Patterns of Anthelmintics in the United States Military: A Retrospective Analysis. Open Forum Infect Dis 2022; 9:ofac040. [PMID: 35187196 PMCID: PMC8849283 DOI: 10.1093/ofid/ofac040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/25/2022] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Recent price increases in medications used to treat helminth infections have had demonstrated impacts on Medicaid and immigrant patient populations. Helminth infections are common within the US military; however, anthelmintic prescribing patterns and costs have not yet been investigated in this patient population. METHODS We conducted a retrospective analysis of pharmaceutical data from the Military Health System Data Repository between fiscal years 2012 and 2019. Prescription information, including costs and demographics, were abstracted for all anthelmintic medications as well as associated helminth diagnostic codes within 30 days of the prescription dispensing date. RESULTS On average, there were 10 871 anthelmintic medications prescribed per year, for a total of 86 697 during the study period. Ivermectin and albendazole were each prescribed >34 000 times. There were 15 498 mebendazole prescriptions and 1327 praziquantel prescriptions. The total cost of all anthelmintic prescriptions was $16 018 381. Annual costs for anthelmintic medications increased 16-fold during the study period, up to nearly $5 000 000 in fiscal year 2019, primarily driven by price increases in albendazole and mebendazole. Albendazole prescriptions accounted for $12 282 891 of total costs (76.7%), though only 39.1% of total prescriptions. The most common diagnosis associated with albendazole and mebendazole prescriptions was enterobiasis. CONCLUSIONS Price increases in anthelmintic medications have significantly impacted the costs borne by the US government for treating parasitic infections. There are a substantial number of anthelmintic prescriptions in the US military health care system annually, suggesting a higher number of helminth infections than previously thought.
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Affiliation(s)
- Alyssa R Lindrose
- Department of Microbiology & Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Jamie A Fraser
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Patrick W Hickey
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Edward Mitre
- Department of Microbiology & Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Chahal HS, Fowler AC, Patel R, Shimer M. Characteristics and Outcomes of Products Seeking Competitive Generic Therapy Designation and Exclusivity. JAMA 2021; 326:1863-1865. [PMID: 34751720 PMCID: PMC8579229 DOI: 10.1001/jama.2021.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study describes the process used by the US Food and Drug Administration to review potential generic drugs for Competitive Generic Therapy (CGT) designation and marketing exclusivity as well as the characteristics and outcomes of products that have sought CGT designation and exclusivity from 2017-2020.
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Affiliation(s)
- Harinder Singh Chahal
- Office of the Commissioner, US Food and Drug Administration, Silver Spring, Maryland
| | - Annabelle C. Fowler
- Office of the Commissioner, US Food and Drug Administration, Silver Spring, Maryland
| | - Rinku Patel
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Martin Shimer
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
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Alpern JD, Vazquez‐Benitez G, DeFor TA, Stauffer WM, Shahriar AA, Kodet AJ, Pawloski PA, Dehmer SP. Population characteristics, use, and spending on sole‐source, off‐patent drugs among commercial insurance members in the United States—An analysis of outpatient claims data at a single health plan. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jonathan D. Alpern
- HealthPartners Institute Bloomington Minnesota USA
- Department of Medicine University of Minnesota Minneapolis Minnesota USA
| | | | | | | | | | - Amy J. Kodet
- HealthPartners Institute Bloomington Minnesota USA
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Affiliation(s)
- Michelle M Mello
- Stanford Law School, Stanford, California
- Stanford Health Policy and the Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Trish Riley
- National Academy for State Health Policy, Portland, Maine
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Son KB. Understanding long-listed pharmaceutical products without competition in South Korea: policy implications in managing generic entrants and pharmaceutical expenditures. Expert Rev Pharmacoecon Outcomes Res 2021; 22:815-822. [PMID: 33765402 DOI: 10.1080/14737167.2021.1908890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: The nature of competition within the pharmaceutical sector has received a great deal of attention from policymakers and researchers. This is the first study to comprehensively analyze long listed single-source products within the South Korean market.Methods: Long listed single-source products are defined as pharmaceutical drugs that are available in the market for at least 8 years, without competition. We analyzed the determinants that lead to long listed single-source products in the market, and then evaluated their impact on health systems by examining the subsequent price responses of manufacturers.Results: Based on the number of drugs and their market values, pharmaceuticals categorized as long listed single-source products constitute a substantial portion of the market. Characteristics of the market are closely associated with generic entrants. In particular, the market size of a substance is associated with generic entrants, while the price of a brand-name drug is related to being long listed single-source products.Conclusions: Our analysis supports the creation of a regulatory and/or reimbursement system in order to support robust and effective competition within the marketplace. The first step toward rationalizing the system is to provide widespread information on drugs with limited competition or no competition.
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Affiliation(s)
- Kyung-Bok Son
- Pharmaceutical Economics and Policy, School of Pharmacy, Sungkyunkwan University, Suwon-si, Republic of Korea
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Mello MM, Riley T. To Address Drug Affordability, Grab the Low-Hanging Fruit. JAMA HEALTH FORUM 2021; 2:e210260. [DOI: 10.1001/jamahealthforum.2021.0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michelle M. Mello
- Stanford Law School, Stanford, California
- Stanford Heath Policy and the Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Trish Riley
- National Academy for State Health Policy, Portland, Maine
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Kakkar AK. Pharmaceutical price regulation and its impact on drug innovation: mitigating the trade-offs. Expert Opin Ther Pat 2021; 31:189-192. [PMID: 33435784 DOI: 10.1080/13543776.2021.1876029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ashish Kumar Kakkar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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