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Drug costs - as TKI's come off patent - they should get much cheaper, but ...


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#1 scuba

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Posted 05 May 2015 - 09:31 AM

Quoted from The Economist this morning:

 

Generic question: drug mergers and prices

Mylan, a maker of generic drugs, announces first-quarter results today. Financial analysts are optimistic: the Dutch-domiciled company has already launched five products this year. It is in the spotlight for another reason, too: it is in the middle of a three-way takeover fight. Teva Pharmaceutical Industries, an Israeli firm, has offered $40 billion for Mylan; Mylan, in turn, has bid $35.6 billion for Perrigo, which makes over-the-counter medicines and is domiciled in Ireland. Both offers have been rejected. But the proposals have prompted debate over whether mergers would cause a rise in the prices of generics (some of which have recently leaped alarmingly). By providing competition to branded drugs, generics bring down the cost of treatment enormously. The question is whether consolidation among generics companies weakens that effect. Analysts are divided. The answer matters: healthy competition is likely to mean healthier people.

  20150509_DAC086.png?itok=B1Plm3G7


Diagnosed 11 May 2011 (100% FiSH, 155% PCR)

with b2a2 BCR-ABL fusion transcript coding for the 210kDa BCR-ABL protein

 

Sprycel: 20 mg per day - taken at lights out with Quercetin and/or Magnesium Taurate

6-8 grams Curcumin C3 complex.

 

2015 PCR: < 0.01% (M.D. Anderson scale)

2016 PCR: < 0.01% (M.D. Anderson scale) 

March        2017 PCR:     0.01% (M.D. Anderson scale)

June          2017 PCR:     "undetected"

September 2017 PCR:     "undetected"


#2 PJM

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Posted 05 May 2015 - 11:44 AM

It will be interesting to watch as Gleevec comes off patent and  available as a generic.  The truth is that insurance companies make decisions regarding prescription medication  consistently looking for the cheapest alternative and that choice is not always in the best interest of the patient.   Case in point when I was first diagnosed with CML I  spent 1.5 weeks in the hospital.  Because I was Sokal high risk, I was put on Sprycel. This was a proper treatment decision within the TKI guidelines where high risk patients are put on a 2nd generation TKI and not Gleevec.    However, my insurance denied paying for Sprycel and sent us a nasty note saying that under no circumstances would they pay for it unless I tried Tasigna first.  Well I failed Tasigna I was then "allowed" to be on Sprycel.  I failed that too and went to ponatinib which costs the insurance company for 30 mg a ridiculous $23,000 a month. I am sure they pay that reluctantly and I had to jump through some hoops in order for them to do so.   I will never know if my situation today would be different had I been allowed to stay on Sprycel as originally prescribed by my doctor.     My point is this.  It is possible that insurance companies will tie our doctors' hands and insist on the cheaper generic form of Gleevec even if that is not an appropriate choice.  TKIs are among the most expensive cancer medications out there.  I have also read that  Novartis may have patients who have been on Gleevec switch to Tasigna - a move that will keep their coffers overflowing. 



#3 nanakrauss2

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Posted 05 May 2015 - 01:10 PM

The big question is what will be the cost of the generic? It could cost 50% less and still be prohibitive for many. I doubt we will be able to get it at Walmart for $5.99!



#4 scuba

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Posted 05 May 2015 - 02:19 PM

The big question is what will be the cost of the generic? It could cost 50% less and still be prohibitive for many. I doubt we will be able to get it at Walmart for $5.99!

 

India will source it for $200-500 per month. They already do locally. That will be the competitive marker when they are allowed to come into the U.S. after patent expires.

It is customary for the expired patent holder to drop their price to closely match generics but with a small premium by virtue of the brand name (i.e. do you trust us, Novartis, or some firm you never heard of .... ).


Diagnosed 11 May 2011 (100% FiSH, 155% PCR)

with b2a2 BCR-ABL fusion transcript coding for the 210kDa BCR-ABL protein

 

Sprycel: 20 mg per day - taken at lights out with Quercetin and/or Magnesium Taurate

6-8 grams Curcumin C3 complex.

 

2015 PCR: < 0.01% (M.D. Anderson scale)

2016 PCR: < 0.01% (M.D. Anderson scale) 

March        2017 PCR:     0.01% (M.D. Anderson scale)

June          2017 PCR:     "undetected"

September 2017 PCR:     "undetected"


#5 Gail's

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Posted 05 May 2015 - 05:42 PM

I'm on Kaiser insurance. Their formulary is limited to medications they can contract with pharmaceutical companies to keep costs low. It is really not difficult to get brand name or off formulary drugs. Your doc writes a letter stating that is most effective for you. I'm sure at some point they'd hear about it if done routinely but my dr didn't hesitate with two expensive brand names I use. That's how it is now, we'll see how it goes next year when imatinib is off formulary. Fortunately I live in Oregon where insurance has to cover oral cancer meds at the same rate as in hospital chemo, and as a result, I haven't paid a penny for it. I'm hoping to respond well enough and that the trials will establish safe guidelines for cessation so I don't have to take it after I retire.
Diagnosed 1/15/15
FISH 92%
BMB 9:22 translocation
1/19/15 began 400 mg gleevec
1/22/15 bcr 37.2 IS
2/6/15 bcr 12.5 IS
3/26/15 bcr 10.3 IS
6/29/15 bcr 7.5 IS
9/24/15 bcr 0.8 IS
1/4/16 bcr 0.3 IS
Started 100 mg dasatinib, mutation analysis negative
4/20/16 bcr 0.03 IS
8/8/16 bcr 0.007 IS
12/6/16 bcr 0.002 IS
Lowered dasatinib to 70 mg
4/10/17 bcr 0.001 IS
Lowered dasatinib to 50 mg
7/5/17 bcr 0.004 IS
8/10/17 bcr 0.001. Stopped TKI in prep for September surgery.
9/10/17 bcr 0.006
10/10/17 bcr 0.088

#6 Dom

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Posted 05 May 2015 - 06:56 PM

I can see a case in which generic gleevec has different and possibly harsher side-effects than brand gleevec, at least for some of us. On united health care, I have 0 co-pay on all of the tki drugs, and since I have no side-effects worth mentioning from gleevec, I hope nothing in my situation changes.

Now cessation, that's a different ball-game. The one side-effect from gleevec that I'm still not getting past (even after one year) is that every time I take it, I think, "I have cancer, and just 15 years ago, it was always terminal". God, I hate that.

Here's to cessation, for all of us. Someday, we'll be cancer and tki free.

Diagnosed in February 2014. Started Imatinib 400 in April.
2014:     3.18     0.91
2015:     0.22     0.16     0.04     0.55
2016:     0.71     0.66

(Started Imatinib 600 in April 2016)
2016:     0.42     0.13     0.45
2017:     0.17     0.06     0.10     0.06     0.34


#7 Dom

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Posted 05 May 2015 - 06:57 PM

I just thought of a question. If cessation becomes a real possibility, what will happen to the price of the tkis, both brand and generic? Will they go up?

Diagnosed in February 2014. Started Imatinib 400 in April.
2014:     3.18     0.91
2015:     0.22     0.16     0.04     0.55
2016:     0.71     0.66

(Started Imatinib 600 in April 2016)
2016:     0.42     0.13     0.45
2017:     0.17     0.06     0.10     0.06     0.34


#8 rcase13

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Posted 05 May 2015 - 08:10 PM

Supply and demand. If demand goes down price goes down.

10/01/2014 100% Diagnosis (WBC 278k, Blasts 6%, Spleen extended 20cm)

01/02/2015 0.06% Tasigna 600mg
04/08/2015 0.01% Tasigna 600mg
07/01/2015 0.01% Tasigna 600mg
10/05/2015 0.02% Tasigna 600mg
01/04/2016 0.01% Tasigna 600mg
04/04/2016 PCRU Tasigna 600mg
07/18/2016 PCRU Tasigna 600mg
10/12/2016 PCRU Tasigna 600mg
01/09/2017 PCRU Tasigna 600mg
04/12/2017 PCRU Tasigna 600mg
10/16/2017 PCRU Tasigna 600mg
01/15/2018 PCRU Tasigna 600mg

 

Cancer Sucks!


#9 chriskuo

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Posted 06 May 2015 - 02:27 AM

The current drugs will all be off patent before cessation has any real impact on the market.

 

I doubt that the price of generic imatinib will fall to the level in India in the near future.  I have a friend who works for a generic drug manufacturer who is setting up drug production in India.  They have significant quality control issues.  It will take time and MONEY for India to get imatinib production up to US standards.

 

Also, I seriously doubt ARIAD is charging any insurer $23,000 / month for Iclusig.  It sells at a premium to the other drugs in most cases but it is not that much more expensive.  The price of drugs is based on what each country's health system will accept.  The US system is very kludgy but as a practical matter, almost every patient in the US ends up getting their TKIs at a price they can afford. In most other countries, the government is involved in negotiating what they pay for drugs.  In the US, it is illegal for the Federal Goverment to directly negotiate drug prices.   That's why Medicare Part D is so convulated.



#10 PJM

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Posted 06 May 2015 - 04:50 PM

Just to let you know that Iclusig is that expensive. It is prescribed by only 1 pharmacy in the country, Biologics out of North Carolina. Most people who have cml are not on it. Only about 1,000 in the US are. You have to either have the T315i mutation or have failed 2 or more tkis (my case). Whe I was on 15 mg the cost charged by Biologics to United Health Care was $11,520.39 per month. I am now on 30 mg and that cost is $23,039.52 per month. Looking right at my claims summary so I am not kidding you...

#11 Dom

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Posted 06 May 2015 - 06:45 PM

PJM, I have UHC also. All TKIs, at all dosages, have a 0 copay, except 45 mg Iclusig, which is 150.00 per month. You have to buy at optumrx mail order.

Diagnosed in February 2014. Started Imatinib 400 in April.
2014:     3.18     0.91
2015:     0.22     0.16     0.04     0.55
2016:     0.71     0.66

(Started Imatinib 600 in April 2016)
2016:     0.42     0.13     0.45
2017:     0.17     0.06     0.10     0.06     0.34





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