Oct. 29, 2019
Prime Therapeutics Study Finds Tagrisso® New First-line Lung Cancer Treatment Drives Ten-fold Use, $4 Million Cost Increase
Real-world use shows substantially higher total cost of care than other available treatments.
EAGAN, Minn. – A new study from Prime Therapeutics LLC (Prime) shows a ten-fold increase in the use of osimertinib (Tagrisso®) – an epidermal growth factor receptor inhibitor (EGFR-i) – since it became a guideline recommended first-line therapy option in late 2017. These real-world findings of members with non-small cell lung cancer (NSCLC) treated with an EGFR-i show those taking Tagrisso® had a 50% higher total cost of care than those using competitor EGFR-i products, resulting in an additional $4 million in drug costs for payers over two years’ time.
Tagrisso®, approved in 2015 as a second-line therapy, entered the market with an annual wholesale acquisition cost (WAC) of $177,152, which is about $70,000 higher than the first-line drugs on the market at that time. In 2017, the National Comprehensive Cancer Network (NCCN) changed their guidelines to include Tagrisso® as a preferred first-line therapy and Tagrisso® subsequently gained FDA approval for first-line use in 2018. Although gaining a first-line indication, Tagrisso® maintained its second-line, higher pricing, making it important for payers to understand the first-line usage trends and how it affects total cost of care.
Prime analyzed EGFR-i utilization trends and costs using integrated medical and pharmacy claims data from 15 million commercially insured members during January 2017 through June 2019. Researchers found 1,020 members new to EGFR-i therapy and analyzed claims to see what proportion of individuals received Tagrisso® as a first-line therapy, how many discontinued using it as prescribed, and the impact of this real-world use on total cost of care compared to members utilizing a competitor EGFR-i.
Since gaining its first-line approval, three of four individuals starting EGFR-i therapy have received Tagrisso®. That’s a ten-fold increase in use, which puts payers on the hook for the substantially higher cost of Tagrisso® compared to other available treatments.
Findings confirm that the 129 individuals who started on Tagrisso® had a higher total cost of $37,934 over six months compared to individuals who started on a lower priced EGFR-i product. This increased cost equates to over $4 million in additional costs for the 129 treated members. Additionally, the study found one in six members discontinued Tagrisso® therapy during the first six months of use. The high cost combined with the 19% Tagrisso® discontinuation rate indicates the need for value-based contracting.
Eighty-one percent of members continued taking Tagrisso® as prescribed compared to 66% of members using competitor EGFR-is, but when analyzing members who persisted with treatment for six months using Tagrisso® or a competitor EGFR-i, the total cost of care for members using Tagrisso® was $45,000 higher than for members persisting with a competitor EGFR-i.
“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, said Jeremy Whalen, PharmD, BCOP, specialty clinical program director for Prime. “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.”
According to the American Cancer Society (ACS), lung cancer is the second most common form of cancer for men and women and is the leading cause of cancer death in the U.S. The ACS estimates in 2019 there will be about 228,150 new cases of lung cancer. Eighty-four percent of lung cancer cases are NSCLC, with 10% to 50% having an EGFR mutation.1
Prime researchers will present this platinum ribbon-winning study at AMCP Nexus Meeting Oct. 29 – Nov. 1 in National Harbor, Md.
1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®) Non-Small Cell Lung Cancer Version 7.2019. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf last accessed Sept 16, 2019.
About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes healthcare work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 28 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.
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