Rheumatoid arthritis drug prices have risen steeply over the past three years, despite little to no change in composition, experts and insurers say.
The wholesale cost of Enbrel, a drug used to treat a number of chronic conditions, has increased 80.3% since 2013, and now exceeds $4,000 for a 30-day supply, according to data gathered by the Alliance of Community Health Plans. The price of Humira went up 68.7% to roughly $3,700 in the same time frame, and the price of Xeljanz rose 44.3% to over $3,100.
Wholesale prices don't include drugmaker discounts or reductions in price from insurers or pharmacy benefit managers; ACHP couldn't provide figures that take that into account. The Aetna drug cost estimator estimated Enbrel would cost over $1,000, and that's under a high-deductible plan.
The discount card for Enbrel advertises that patients with private insurance won't pay any out-of-pocket costs for their first six months, and then pay no more than $10 out of pocket each month after that. The card provides a maximum assistance of $8,000 per patient, per year.
Humira and Xeljanz offer similar programs, though Xeljanz has a $12,000 maximum. Humira does not list its assistance limit, but notes that “restrictions, including monthly maximums, may apply.”
The ACHP is concerned about the cost to individual patients and the pressure that high drug costs puts on raising premiums. The high cost of rheumatoid drugs and other expensive therapies will likely impact entire health plan populations, said Dr. Sharon Levine, associate executive medical director for the Permanente Medical Group of Northern California, which is a part of Oakland, Calif.-based Kaiser Permanente, an ACHP member.
“The plans don't have the ability to mint money,” Levine said. “This is our members' money. Part of the insurance model is pooling risk and pooling resources to provide for the health needs of all members.”
None of the three drugmakers' discount cards can be used by patients on Medicare, Medicaid or any other government program. A substantial number of rheumatoid arthritis patients are Medicare enrollees, and many struggle to afford any type of self-injectable biologic because of the significant copays, said Dr. William Harvey, assistant professor of medicine and clinical director of rheumatology at Tufts Medical Center in Boston.
Sometimes underinsured patients may have better coverage for hospital services and can find cheaper ways to get similar drugs through intravenous infusions administered by a healthcare provider, which ends up costing the healthcare system more in the long-run. For patients with less severe cases of arthritis, there are also oral medications, the most common being methotrexate.
Patients who still can't afford comprehensive rheumatoid arthritis drugs often use painkillers such as Vicodin or over-the-counter solutions ibuprofen or acetaminophen. But these medications won't slow the progression of the disease, said Harvey, chair of the government affairs committee at the American College of Radiology.
“On the one hand, the revolution that's happened in the last 15 years means we're able to tell patients who are diagnosed that they may never become crippled, and that has tremendous value,” Harvey said. “The problem is that there are still a lot of people who can't access (the drugs) because of their costs.”
An estimated 1.5 million adults had rheumatoid arthritis, according to the Arthritis Foundation. If patients can't treat their chronic condition, that would cost health plans more for hospitalization and long-term care.
The lobbying group Pharmaceutical Research and Manufacturers of America has argued that too many health insurance exchange plans place rheumatoid arthritis drugs on the specialty trier, which increases the patient's cost-sharing responsibilities. Innovator drugs used to treat the disease appear on the specialty tier in 52% of plans in 2015, up 35% from the prior year, according to a PhRMA report. Many of ACHP's members have plans on the insurance marketplaces.
Thousand Oaks, Cali.-based Amgen, which sells Enbrel, said in a statement that its prices “reflect “economic value that is delivered to patients, providers and payers, the unmet medical need, the size of the patient population, the investment and risk undertaken, and the need to fund continued scientific innovation.”
But Harvey points out that patients who take Enbrel and other rheumatoid arthritis drugs pay higher prices to fund research for future drugs that may be irrelevant to their own illnesses.
“There haven't been major improvements in these drugs that would justify the price increases,” Harvey said. “The R&D is not for these drugs, it's for the next things that are going to hit the market.”
Harvey and Levine were also critical of the amount of money that pharmaceutical companies spend on marketing and direct-to-consumer advertising—costs that they believe are being passed on to patients. It's also likely that some of the companies may be hiking prices to maximize profit before potential biosimilar drugs hit the market.
Now that the Food and Drug Administration has released draft guidance on product labeling, biosimilars are one step closer to a smooth, predictable approval process. A biosimilar for Enbrel is one of a number of candidates up for FDA review. Amgen also submitted an application for review of its own biosimilar version of competitor arthritis drug Humira, which is made by North Chicago, Ill.-based AbbVie.
