TOPLINE:

A recent study found that monthly prices of checkpoint inhibitors decreased only slightly from 2015 to 2024, with declines in annual average sales prices ranging from 0.21% to 4.85%.

METHODOLOGY:

• Checkpoint inhibitors have improved survival for many with cancer but are expensive, accounting for almost 20% of Medicare Part B drug spending and high costs for patients.
• As the FDA approves more checkpoint inhibitors, a team of researchers assessed whether competition among these products had led to lower prices.
• Researchers analyzed quarterly average sales prices from Medicare spending files between Q3 2015 and Q1 2024 for 11 FDA-approved checkpoint inhibitors, including ipilimumab (approved in 2011), pembrolizumab (approved in 2014), nivolumab (approved in 2014), and dostarlimab (approved in 2021).
• Prices were standardized to a 28-day (monthly) treatment cost using the FDA label recommended dosage for metastatic non-small cell lung cancer (NSCLC) — an indication shared by most drugs in the study. Prices were adjusted for inflation.
• The researchers assessed pricing trends and compared the FDA-approved indications, as of January 2024, to determine the degree of overlap.

TAKEAWAY:

• Over the study period, average sales prices decreased for all drugs, with average annual decreases ranging from 0.21% to 4.85%.
• Average sales prices of five drugs (pembrolizumab, nivolumab, avelumab, dostarlimab, and retifanlimab) remained within 7% of each other, and five newer drugs (cemiplimab, atezolizumab, durvalumab, tremelimumab, and toripalimab) were introduced at prices 3%-20% lower than those of the existing options at the time. By Q1 of 2024, monthly prices ranged from $7783 for ipilimumab to $14,872 for dostarlimab when dosed for NSCLC; however, the price for ipilimumab was substantially higher for other indications ($15,846 when dosed for colorectal cancer and $47,538 when dosed for metastatic melanoma)
• The researchers identified 55 distinct indications for the 11 drugs, 24 of which were approved for only one drug, as well as 31 overlapping indications. Pembrolizumab dominated the market with 45 of 55 total indications (82%) and 18 of 24 (75%) nonoverlapping indications; pembrolizumab also had the most indications for each overlap category.
• Among eight drugs approved after 2015, three (avelumab, cemiplimab, and atezolizumab) were initially launched for nonoverlapping indications at a mean price of $14,697, whereas five (durvalumab, dostarlimab, retifanlimab, toripalimab, and tremelimumab) were launched for overlapping indications at a lower mean price of $13,470.

IN PRACTICE:

"Prices of checkpoint inhibitor medications to treat cancer did not meaningfully change from 2015 to 2024 with the entrance of new brand-name drugs with the same mechanism of action," the authors wrote. "Lack of overlap of FDA-approved indications among these drugs, as well as the market dominance of pembrolizumab, may partially explain why competition has not substantially lowered prices." 

SOURCE:

The study, led by Jeddeo M. Paul, MD, MBA, with Brigham and Women's Hospital and Harvard Medical School in Boston, was published online in JCO Oncology Practice.

LIMITATIONS:

The analysis was limited to prices and FDA approvals, without assessing patterns of use or spending. Cross-label prescribing practices were not examined, although some payers restrict reimbursement to FDA-approved indications. The study used average sales prices reported by drug manufacturers to CMS, so prices may vary among individual payers. Additionally, the analysis of overlapping indications was static as of January 2024 and did not reflect the dynamic nature of FDA approvals. 

DISCLOSURES:

The study received support from Arnold Ventures, Commonwealth Fund, Kaiser Permanente Institute for Health Policy, and Alosa Health. One author had payments listed in Open Payments. Another author reported consulting for Alosa Health and received institutional research funding from Elevance Health and Humana Healthcare Research. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.