Huge savings could be made on generic oncology drugs if the current Part D Medicare formulary prices were replaced with pricing from the Mark Cuban Cost Plus Drug Company (MCCPDC), according to a new study.
The authors estimate that $661.8 million would be saved if seven generic oncology drugs were purchased from the Mark Cuban plan. The drugs were abiraterone, anastrozole, imatinib (100 mg and 400 mg), letrozole, methotrexate, raloxifene, and tamoxifen.
The savings varied for the individual drugs studied. Two drugs accounted for the bulk of savings: abiraterone alone accounted for roughly half of the money saved ($338 million), and imatinib 400 mg accounted for $212 million.
“Both doctors and patients should be aware of cash-pay options available that might offer lower prices to beneficiaries purchasing outside of their health plans and the impact that this drug price stewardship could have on Medicare and Part D sponsors,” said first author Ruchika Talwar, MD, a urologic oncology fellow at Vanderbilt University Medical Center, Nashville, Tennessee, in a statement. “These findings are of utmost importance.”
The study was published June 8 in the Journal of Clinical Oncology.
As previously reported by Medscape Medical News, last year, billionaire entrepreneur Mark Cuban, owner of the NBA’s Dallas Mavericks, launched a company that offers generic drugs at prices that are substantially lower than the current market listings. It is now selling more than 350 generic prescription drugs at the cost of ingredients and manufacturing plus a 15% margin, a $3 pharmacy dispensing fee, and a $5 shipping fee. The company’s inventory continues to expand.
Several studies have investigated the potential large-scale savings of MCCPDC. One study estimated that Medicare could save more than $1 billion each year just for drugs commonly used in urology. As with the current study, abiraterone was a major driver in the cost savings.
Cash Pay Prices a Better Deal
For this latest study, Talwar and colleagues estimated the potential savings if Medicare Part D plans were to use pricing similar to that offered under the MCCPDC for seven generic oncology drugs.
They calculated total Medicare Part D spending for the seven drugs as a group and separately using reported unit prices for the third quarter (Q3) of 2022. They assumed a sales volume that included all brand and generic units dispensed in Part D in 2020. This estimated spending was then compared to the cost if these reported unit prices were replaced with the MCCPDC unit prices.
The total savings ranged from $228.1 million (56.1%) to $2154.5 million (92.4%), assuming plan prices were equal to the 25th or 75th percentiles of Q3-2022 Part D plan unit prices.
The median savings from replacing Part D plan prices with those from MCCPDC were as follows: abiraterone, $338.0 million; anastrozole, $1.2 million; imatinib 100 mg, $15.6 million; imatinib 400 mg, $212.0 million; letrozole, $1.9 million; methotrexate, $26.7 million; raloxifene, $63.8 million; and tamoxifen, $2.6 million.
All 30-day prescription drug prices offered by MCCPDC generated cost savings except for three drugs that were offered at the 25th percentile of Part D formulary pricing: anastrozole, letrozole, and tamoxifen.
The team also evaluated the median cash pay prices. For abiraterone, the cost was $562.49 with Plan D pricing; a 30-day prescription offered under the MCCPDC model was $44.60. The median price for imatinib 100 mg was $442.32. The price for imatinib 400 mg was $1480.29; that price dropped to $44 under the MCCPDC model.
The authors emphasize that the “cash-pay” prices offered by MCCPDC for several of oncology drugs, such as imatinib and abiraterone, were lower than what a person would pay using the Medicare Part D plans, even under catastrophic coverage.
“The MCCPDC is one of several companies that aim to address a real problem for consumers ― the costs of generic drugs,” said co-author Stacie Dusetzina, PhD, professor of health policy at Vanderbilt, in a statement. “This study highlights that, in some cases, Part D plans and their pharmacy benefits managers aren’t doing a good enough job at getting favorable prices for generic drugs for Medicare and its beneficiaries. In some cases, we find that Medicare beneficiaries would overpay by a lot if they used their Medicare benefit to fill one of these cancer drugs. That shouldn’t happen.”
Talwar has disclosed no relevant financial relationships. Dusetzina has relationships with the Institute for Clinical and Economic Review, Arnold Ventures (inst), Leukemia and Lymphoma Society (inst), the Commonwealth Fund (inst), West Health, the National Academy of State Health Policy, the Robert Wood Johnson Foundation (inst), and the Medicare Payment Advisory Commission.
J Clin Oncol. Published online on June 8, 2023. Full text
Roxanne Nelson is a registered nurse and an award-winning medical writer who has written for many major news outlets and is a regular contributor to Medscape.
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