The cancer progression-pausing power is extraordinary. So are the risks and the costs. The U.S. Food and Drug Administration (FDA) approved Ibrance in February 2015 to treat a certain type of breast cancer in postmenopausal women. And uptake has taken off. At a cost of $476 per capsule, this latest specialty blockbuster has the potential to increase pharmacy costs for all stakeholders — not just people facing breast cancer.
What we studied
To learn what impact Ibrance could have on pharmacy benefit costs, our research team analyzed member use between February and June of 2015. We studied claims data from 18.6 million commercial and Medicare members. Of these members, 379 were identified as using Ibrance.
What we learned
When analyzing the data, we learned that:
- Ibrance use and spend in Medicare populations is disproportionately high. Medicare members’ utilization and PMPM costs were five times higher than the commercial population.
- Per member per month (PMPM) Ibrance costs are rising rapidly. During the study period, PMPM costs for Medicare members increased from $0.07 to $0.91. Commercial PMPM costs grew from $0.02 to $0.17. If the trend continues, PMPM costs will be $2.52 and $0.46, respectively, in the twelfth month post-launch.
- Therapy discontinuation rates are high — and leading to significant waste.
- One in 6 members underwent a dose reduction. In one third of these cases, overlap between fills caused drug waste and resulted in excess spending of $4,405 per user.
- One in 6 members discontinued therapy, potentially due to adverse events or treatment failure. Waste for these members was not measured, but likely high.
- Guidelines for accompanying therapy are not being followed. Labeling guidelines for Ibrance require use of letrozole at the same time, as clinical efficacy depends on these dual therapies. One in 10 members had no evidence of letrozole use.
Why we did this study
Ibrance can greatly improve health outcomes. But careful management of this expensive therapy is critical to achieving positive health results and maintaining a sustainable health system. As use continues to ramp up, it is increasingly important for plan sponsors to make use of pharmacy management tools. Programs such as split fill (splitting the initial fill into two to assess dosage and side effects) and care management (guidance to foster adherence to the drug and clinical guidelines) can help to minimize waste and costs, and maximize health outcomes.
Review the study poster, presented Oct. 26–29, 2015 at the Academy of Managed Care Pharmacy (AMCP) Nexus event in Orlando, Florida. >>