More competition and lower prices in this class of treatments is greatly needed, says Dr. Worthing.
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“Specialty drugs, such as biologics, are only 1% of prescriptions in the U.S., but they constitute about a quarter of the U.S. drug spend. High drug prices in rheumatology are likely driving a lot of the administrative hassles and barriers to care, such as prior authorization and step therapy. This is why it’s critical to get biosimilars to market efficiently,” says Dr. Worthing.
In a March 21, 2017, address to Congress, FDA Director Janet Woodcock, announced the hiring of additional staff to manage biosimilar approvals. Dr. Worthing says, “I am thrilled to see that the FDA can start hiring the experts needed to approve the backlog of 60+ biosimilars currently in the pipeline.”
Until biosimilars come down in price—if they do—other rheumatologists are skeptical about the benefit to arthritis patients already strapped with high costs for other medications and areas of care.
“I was a little disappointed when I saw the first pricing for the biosimilars. If you look at the costs, they are pretty comparable to the biologics, which was surprising,” says Piyush Poddar, MD, a rheumatologist with Sanford Health in Bismarck, N.D. “I have patients on Medicare who, if they don’t have supplemental, commercial policies too, they can’t afford biologics. Their monthly copay may be $1,000–2,000 a month. Some of my patients say they try to stretch the doses. They split their dose of some drugs. The drugs lose their efficacy.”
Pricey biologics are not the only source of rising costs that concern rheumatologists. Generic drugs for rheumatologic conditions are going up in price, too.
“The costs that concern me the most are the high cost for a number of common generic medications, such as colchicine for gout and metalazone (Skelaxin), a non-sedating muscle relaxer,” says Scott Zashin, MD, a rheumatologist in private practive in Dallas. “These medications carry inexplicably high costs and can be a barrier to effective treatment.”
At his Omaha clinic, Dr. O’Dell is concerned by the rising costs of generic colchicine and hydroxychloroquine (Plaquenil). According to GoodRx.com, the average retail price of 60 tablets of 200 mg hydroxychloroquine is $220.05.
“Hydroxychloroquine has been used for 60 years at least. It used to be pennies a pill, and now it’s dollars a pill,” says Dr. O’Dell. He believes rising prices for generics are due to market forces, not research or development costs. “Hydroxychloroquine is a necessary medication for every patient with lupus. They should be on it and be taking it forever. Yet my lupus patients come in and say, ‘Doc, I’m not taking my hydroxychloroquine,’ or maybe, ‘I am taking a half dose, because I can’t afford it.’ That’s tragic.”