Payers Should Take Action on Rising NSCLC Costs

November 29, 2019

A new report outlines the sharp cost increase associated with a NSCLC drug’s move from second-line to first-line treatment, and suggests payers work with manufacturers to address treatment pricing.

Three out of four patients with non-small cell lung cancer (NSCLC) are now using osimertinib over older tyrosine kinase inhibitors, but the costs associated with this treatment and its uptick in use have skyrocketed.

Originally approved as a second-line therapy for NSCLC in 2015, osimertinib was designated as a preferred first-line agent by the National Comprehensive Cancer Network in 2017, and the FDA approved osimertinib as a first-line treatment for NSCLC in 2018. While patients have benefitted from the first-line designation, costs have skyrocketed. Patient use went from 7% of patients opting for osimertinib in 2017 to 71% by 2019, according to a report from Prime Therapeutics. The study also reveals that 129 patients taking osimertinib generated $4 million more in medical costs over just six months compared with patients taking competing medications.

Osimertinib’s efficacy as a first-line treatment was investigated in a recent study presented at the European Society for Medical Oncology Congress and published in the Annals of Oncology, and showed that it extended overall survival in patients with NSCLC compared with older tyrosine kinase inhibitors gefitinib and erlotinib. Osimertinib was also effective against the most common mutation responsible for resistance to previous treatments, according to the study, and appears to be effective against brain metastases. Lastly, the study notes that patients taking osimertinib were able to extend their time between treatments, from 13.4 months with prior therapies, to 25.9 months with osimertinib.

Cost is an issue

Cost is an issue, though. Osimertinib’s wholesale acquisition cost is more than $177,000 per year-1.7 times higher than other EGFR-1 treatments-and the number of patients using osimertinib has increased 10-fold since 2017. This has raised the average cost of care for patients taking osimertinib by more than 100%, according to the study, which reviewed more than 15 million commercial insurance claims.

Related: Altering Drug Dosages Can Benefit Patient’s Pockets

Jeremy Whalen, PharmD, BCOP, specialty clinical program director at Prime Therapeutics, says part of the challenge is that osimertinib was originally approved as a second-line therapy, and therefore was priced for a smaller patient pool. When first-line designation was granted, osimertinib retained its second-line therapy pricing

“When a drug obtains a first-line indication along with substantial utilization increase without a total cost of care offset, payers are obligated to engage with the manufacturer to seek pricing to value,” Whalen says. “Payers need to maintain high-cost drug therapy vigilance, quickly identify utilization changes, assess total cost of care and actively seek out value-based contract opportunities.”

Whalen says one in six patients discontinue therapy with osimertinib during the first six months, highlighting the need for payers to use value-based contracting to recoup the drug cost waste associated with therapy failure.

“Payers can work with manufacturers to help ensure their drugs are priced to value,” he says. “Sound utilization management programs may be employed to make sure the right member is receiving the most appropriate, efficacious therapy.”

Rachael Zimlich, RN, is a writer in Columbia Station, Ohio.