High-Cost "Specialty" Brand Drugs
Driver of both Pharma & PBMs: Center of the Collusive Pricing Scheme
Greatest Areas of U.S. Brand Drug Pricing Abuse: Extreme-Cost "Specialty Drugs"
- After widespread U.S. patent expirations last decade, high-cost "specialty" drugs accounted for a large proportion of the remaining "blockbuster' U.S. brand drugs
- Multiple sclerosis, diabetes, cancer, rheumatoid arthritis, rare/orphan diseases and few others
- Massive price increases on "old" U.S "specialty" drugs has led to even higher prices on new drugs reaching the market
U.S. Brand Drugs in the Two Whistleblower Cases
- Multiple Sclerosis: Biogen’s Avonex and Tecfidera; Teva’s Copaxone; Pfizer/EMD Serono's Rebif; Bayer's Betaseron; Novartis' Gilenya
- Insulins: Sanofi’s Lantus and Eli Lilly’s Humulin
- Cancer Drugs: Novartis’ Gleevec and Tasigna; Bristol-Myer's Sprycel
- Rheumatoid Arthritis: AbbVie’s Humira and Amgen’s Enbrel
- Other Major U.S. brands: Pfizer's Lyrica, Premarin, Viagra, Celebrex, Chantix and Relpax
High-Cost "Specialty" Drugs:
- Massive secret "pharma fees" to Health Insurer/PBMs, while minimal "rebates/discounts" for patients, clients and taxpayers
- "Pharma fees": tied directly to massive "sticker" prices and price increases in secret national contracts
- Often as Rxs were rapidly declining
- Health insurers/PBMs standardly keep ALL "pharma fees"
- Health insurer/PBM typically gets an 8% "pharma fee" based on a U.S. "specialty" drug's "sticker" price
- "Pharma fees": tied directly to massive "sticker" prices and price increases in secret national contracts
- "Specialty" drug rebates/discounts are typically small or absent despite massive U.S price increases
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- U.S. multiple sclerosis (MS) manufacturer rebates: only 7% in 2011 to 2016
- Despite a massive increase in U.S. MS drug prices from $15K/patient/yr range in 2005 to the $100K range now
- Link to the District of Rhode Island (D-RI) Whistleblower case discussion of the 2017 PBM industry report admitting the low level of MS drug rebates despite massive U.S. price increases
- U.S. multiple sclerosis (MS) manufacturer rebates: only 7% in 2011 to 2016
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- U.S. rheumatoid arthritis (RA) rebates: only 11% in 2011 to 2016
- Despite a massive increase in U.S. RA drug prices from the $12K/patient/yr range in 2005 to the $75K range now
- Link to the SDNY Whistleblower case discussion of the 2017 PBM industry report admitting the low level of RA drug rebates despite massive U.S. price increases
- U.S. rheumatoid arthritis (RA) rebates: only 11% in 2011 to 2016
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- U.S cancer drug rebates are often minuscule or zero
- Despite a massive increase in U.S. cancer prices over the past decade
- Link to the Whistleblower case discussion of the Express Scripts CEO public admission of the lack of manufacturer rebates for cancer drugs despite massive U.S. prices and price increases
- U.S cancer drug rebates are often minuscule or zero
- Typical U.S "specialty" drug prices and "fees" paid to the dominant health insurer/PBMs:
"Sticker" Cost/Patient/Yr Fees/Patient/Yr (8% rate)
Cancer drug $200K-300K $16,000-24,000
Multiple Sclerosis $100K $8,000
Rheumatoid Arthritis $75K $6,000
- What are the massive "Specialty" drug "pharma fees" being paid to the health insurer/PBMs for?
- Often driven only by massive price increases for brands in sharply declining use
- Health insurer/PBMs getting a lot more "pharma fees" for doing a lot less legitimate work to support patients
- "Old" blockbuster MS, rheumatoid arthritis and other "specialty" drugs that patients have been using chronically for many years
- Biogen's Avonex and Teva's Copaxone (MS, U.S. launch 1996); Amgen's Enbrel and AbbVie's Humira (RA, U.S. launch 1997 and 2003, respectively; Novartis' Gleevec (cancer, U.S. launch 2001); Sanofi's Lantus and Eli Lilly's Humulin (U.S. launch 2000 and 1982, respectively
- Often little legitimate PBM "support" for these "old" "specialty" drugs, beyond shipping Rxs to patients from mail order pharmacies