Seven Most Out-Of-Reach Drugs for Patients Due to High Costs

High prices for drugs generally exist when they are patented and serve a specific need with little or no “good” lower cost alternatives available, according to Ed Francis, senior director and leader of life sciences for West Monroe Partners. “The high-cost prescriptions today tend to exist for biologic drugs. Ultimately, the costs will come down as patents expire and biosimilars come into the market,” he says.

“Biosimilar manufacturing is far more complicated than small-molecule generics so there will likely be some delays in bringing drugs online and ultimately the price may still be higher than a typical small-molecule drug,” Francis says.

Eculizumab (Soliris), developed for the treatment of myasthenia gravis, a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, has an annual cost of over $500,000, according to John Sarich, VP of strategy, VUE Software, a firm that specializes in innovating and automating business processes for the insurance industry.

“The 39 most expensive drugs in the U.S. range from an annual cost of low $10,000's to high $500,000's,” Sarich says. “They are designed to treat very serious medical conditions. It should be noted that pharmaceutical companies are international businesses with drug manufacturers spread throughout the world. While subsidies abound, the U.S. does, in fact, pick up a disproportionate share of the drug costs.”

“Employers and plan members need to be aware of high-cost ‘combo’ drugs where two or more inexpensive drugs are mixed together and marketed as a ‘new’ expensive drug,” says Cheryl Larson, president and CEO, Midwest Business Group on Health.

“One example is Duexis, used to treat symptoms of rheumatoid arthritis and osteoarthritis. The cost is about $1,080 for a 30-day supply, but what many don’t know is that this is a combination of two inexpensive drugs-ibuprofen and famotidine,” Larson says. “You can buy a 30-day supply of ibuprofen for less than $10 and famotidine (an antacid and antihistamine such as Pepcid) for less than $5.”

“In an attempt to decrease abuse of prescription opioids, several manufacturers have produced name-brand only special formulations of extended-release opioids designed to deter abuse,” says Victor Chin, MD, medical director for Paradigm Management Services, LLC.

Extended-release ADF opioids are often more expensive than generic opioid formulations, says Chin. “Although it would be a societal benefit if less opioids were abused, the question is who should bear the increased cost? Should it be the patient? Should it be society? Or should it be the insurer? Some state legislators have passed legislation requiring ADF opioids to be covered under insurance policies. If we have good research data, then we can make a more informed decision about the cost/benefit ratio of these medications.”

Naloxone has been available in generic intravenous formulation for decades, according to Chin. “It was previously relatively inexpensive,” he says. “In the past five-plus years as the opioid crisis has intensified, use of this medication has skyrocketed along with the price.  There are several formulations available on the market at present.”

In 2014, the FDA approved Evzio naloxone auto-injector. “Initially when this came out the price was around $690 retail but in 2017 the price increased to $4,500,” says Chin. “Several of my patients have been unable to afford the copay for this medication so I have changed to prescribing Nasal Narcan, a brand-name product with a retail price around $135.”