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:

  • "Specialty" drug rebates/discounts are typically small or absent despite massive U.S price increases

                            "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


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