New research suggests that spending on anticancer agents is moderating, going against national trends that suggest an uptick in the US prescription drug expenditures this year.
In general, prescription drugs account for approximately 11% of overall US healthcare expenditures. Like other healthcare expenditures, growth in prescription drug spending has moderated substantially in recent years, and in 2012 spending actually decreased 0.8% compared with the previous year.1
However, this trend is anticipated to begin to reverse by 2014.
A projected 3–5% increase in total drug expenditures across all settings is anticipated, with a 5–7% increase in clinic spending and a 1–3% increase in hospital spending.
Glen T. Schumock, PharmD, MBA, PhD, and colleagues assessed trends in expenditures for oncology therapies in hospitals and clinics. The researchers examined the market share of the mail-order sector from 2003 to 2012 for capecitabine, temozolomide, and agents used to treat breast cancer (lapatinib), lung cancer (erlotinib and crizotinib), chronic myeloid leukemia (imatinib, dasatinib, nilotinib, and ponatinib), prostate cancer (bicalutamide, enzalutamide, and abiraterone), and renal cell carcinoma (axitinib, everolimus, pazopanib, sorafenib, and sunitinib). Their findings
were published in The American Journal of Health-System Pharmacy
“Oncologists and hematologists are going to order and use what’s clinically appropriate,” said coauthor Edward Li, PharmD, BCOP, associate professor of Pharmacy Practice at the University of New England College of Pharmacy in Portland, Maine. “But it’s interesting to see which agents that were at the top of the expenditure list are now at the bottom, like oxaliplatin.”
In the clinic setting, substantially decreased expenditures for oxaliplatin and docetaxel were observed in 2013. They suggest that a contributing factor in decreased spending on oxaliplatin may be the reduction in the CMS-calculated average sales price in 2012, likely due to the availability of a generic product. Because oxaliplatin was the fourth highest antineoplastic drug expenditure for clinics in 2012, this change alone moderated the total growth of antineoplastic drug expenditures in 2013. The decrease in docetaxel expenditures is likely due to lower utilization, especially for prostate cancer indications, for which other therapies such as abiraterone are gaining favor.Oral Oncolytics
Similar to trends in 2012, the authors report that the majority of new cancer agents introduced in 2013 (four out of five) were oral agents (afatinib, dabrafenib, ibrutinib, and trametinib) and thus unlikely to notably affect hospital or clinic expenditures, as they are not usually initiated during a patient’s hospital stay and are not administered by a practitioner in the outpatient clinic setting.
The study recommended that hospitals should recognize that the development of oral oncology agents is an ongoing trend, as is hospital management of oncology treatment decisions (which include oral therapies).2,3
Further, over the past decade, there was growth in expenditures on several important oral oncology agents within the mail-order distribution channel. This trend confirms the anecdotal sentiment that the distribution of oral oncology agents is being driven toward channels other than clinics and traditional retail pharmacies. The impact of this trend on health system pharmacy budgets is mixed.
The authors of the study concluded that pharmacy leaders will need to consider this paradigm shift as part of their plans for future clinical, professional, and distributive services and recognize that the traditional “buy-and-bill” model cannot be relied on to provide remuneration for the clinical services provided.
1. Cuckler GA, Sisko AM, Keehan SP et al. National health expenditure projections, 2012-22: slow growth until coverage expands and economy improves. Health Aff (Millwood). 2013; 32:1820–31.
Schwartz RN, Eng KJ, Frieze DA et al. NCCN task force report: specialty pharmacy. J Natl Compr Canc Netw. 2010; 8(suppl 4):S1–12.
Li E, Schleif R, Edelen B. Hospital management of outpatient oncology treatment decisions: a survey to identify strategies and concerns. J Oncol Pract. 2013; 9:e248–54.