One cancer drug, two diabetes drugs and two next-generation blood thinners topped the Medicare Part D charts for 2017—all with sales of more than $2.5 billion apiece. But two other numbers stood out at the top of the list: the 15%-plus price increases for Celgene's Revlimid and Pfizer's Lyrica.
Those hikes helped put Revlimid, which treats multiple myeloma, at the top with $3.3 billion in Medicare spending and Lyrica, a pain drug, in seventh with $2.5 billion.
As politicians, consumers and the press keep a close eye on drug costs, the Centers for Medicare and Medicaid Services has rolled out a slew of numbers Thursday to fuel the pricing debate. Medicare Part D drug spending totaled $154.9 billion in 2017, while Part B spending came in at $30.4 billion and Medicaid spending at $67.6 billion.
In Medicare Part D—drugs that patients self-administer—only Celgene's Revlimid and Bristol-Myers Squibb and Pfizer’s Eliquis passed the $3 billion spending threshold. Celgene and BMS are set to tie up next month pending an investor vote, putting Revlimid and BMS' share of Eliquis under one roof.
Eliquis, one of the next-gen anticoagulants on the list, posted a per-unit cost increase of 9.4% in 2017 versus the prior year, nearly 6% less than Revlimid's boost. And while Revlimid commanded an average spending per beneficiary of $88,000 in 2017, Eliquis accounted for nearly $2,700. Average spending per dose came in at $627 for Revlimid—with its much smaller market in cancer—and $6.42 for Eliquis, a mass-market cardiovascular therapy.
Other Part D blockbusters
Beyond the top two drugs in the ranking, Merck’s Januvia, Sanofi’s Lantus Solostar, J&J’s Xarelto, Gilead’s Harvoni and Pfizer’s Lyrica each passed the $2.5 billion mark in 2017 Part D spending. All but Harvoni have had average price increases of about 10% over the past five years. Average costs for Harvoni, which has been suffering from pricing pressure, fell over the period. Combining Sanofi's Lantus and Lantus Solostar would push that drug to the top of the 2017 spending rankings.
AbbVie’s Humira, which has made headlines for its repeated price hikes, turned in a per-unit boost of 13%, just two points shy of Revlimid and Lyrica, fueling spending of just over $2 billion. Over the previous five years, though, Humira's price per dose grew nearly 18%.
Other drugs in the top Part D spending rankings for 2017 include Teva's Copaxone, GlaxoSmithKline’s Advair, Boehringer Ingelheim’s Spiriva and AstraZeneca’s Symbicort.
Medicare Part B and Medicaid
In Part B, drugs administered by doctors and hospitals, spending numbers came in lower. Regeneron's Eylea, Roche’s Rituxan and Bristol’s Opdivo topped the spending charts at annual expenditures of $2.47 billion, $1.76 billion and $1.47 billion respectively. Their prices were either slightly up or flat. Among the top drugs by Medicare Part B spending in 2017, Bristol’s Orencia turned up the largest increase in 2017 at 13%. Other increases were in single digits, while pricing for some drugs fell.
In Medicaid, Humira, Harvoni and Latuda topped spending rankings with more than $1 billion. Humira and Latuda posted price increases of 12% and 14% respectively, while average pricing for Harvoni was slightly down in 2017. Beyond those drugs, Shire’s ADHD drug Vyvanse commanded nearly $1 billion in Medicaid spending; its pricing was up 7% for the year. Gilead’s Epclusa rounded out the top five in Medicaid spending for 2017, but the hep C drug also posted the biggest pricing decrease among the group at 6.8%. Gilead has been under pricing pressure in the field and recently launched authorized generics to its own big-selling Harvoni and Epclusa.
The Trump administration says it's releasing the data as part of an effort to increase transparency into drug pricing. A nationwide debate over drug costs has escalated in recent years, leading to new measures to rein in prices that include nixing rebates for public health systems, forcing drugmakers to include prices in DTC ads and more.
Pharma has been open to many of the administration’s proposals, but one idea is getting a high level of industry pushback. The Trump administration’s international price index would force lower Medicare Part B prices over five years by tying U.S. prices to a group of 16 other developed nations. Drugmakers have launched a campaign against the proposal, saying it brings foreign price controls to the U.S.