Novartis rolls out flex pricing scheme for newly approved Ibrance rival Kisqali

Plenty of companies have talked about—and even dabbled in—newfangled pricing schemes. But Novartis is about to seriously raise the bar with new cancer-fighter Kisqali.

The med—a first-line treatment for HR-positive, HER2-negative breast cancer that will compete with Pfizer’s Ibrance—will roll out as early as Tuesday under a flexible pricing structure, the company said on a conference call following Monday's FDA approval. A 28-day supply of the 600-mg dose will cost $10,950, while the same supply of the 400-mg dose will go for $8,760 and the 200-mg dose will run at $4,380.

It’s not Novartis’ first time going outside the box when it comes to pricing schemes, and judging by chief exec Joe Jimenez’s assessment of the current landscape, it won’t be the last, either. The company was ahead of the curve with its Entresto pay-for-performance deals early last year, pricing the heart failure med according to the value it brought payers.

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"We will see a more difficult pricing environment in the U.S.,” Jimenez told the Financial Times last summer, adding that “we all have to plan for new pricing models in the U.S. that could help us ensure the sustainability of the system as the population ages.”

Meanwhile, Kisqali’s wholesale prices are below those of the competition, the Swiss drugmaker was quick to point out. “At the time of launch, Kisqali will be the CDK 4/6 inhibitor with the lowest WAC price and, with the flexible pricing structure, we anticipate it will have an ~18% to 20% lower aggregate cost based on the dosing seen in the trial,” a company spokeswoman said by email.

While Kisqali may beat Ibrance on price, though, when it comes to safety and convenience, Pfizer’s blockbuster may have the newcomer beat. Regulators recommend patients receive ECG monitoring before starting up treatment with the Novartis med and repeat it at day 14 of the first cycle and the beginning of the second cycle.

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The reason? Mild cardiac arrhythmias—as well as one drug-related sudden death—that cropped up in some patients during trials and had industry watchers wondering whether a black box warning—ultimately not adopted by the FDA—could be in order. And while company R&D chief Vas Narasimhan has said in the past that oncologists are used to keeping an eye on the use of agents in these patients and called the monitoring “relatively routine,” some analysts lowered their expectations when he first announced the monitoring possibility on last year’s third-quarter conference call.

That’s not to say the markets expect Kisqali to struggle by any means. Even with another potential competitor—Eli Lilly candidate abemaciclib—heading toward the market, EP Vantage has pegged Novartis’ entrant as the seventh biggest that’ll roll out this year, with an estimated $1.6 billion in 2022 sales.