A quantitative analysis of escalating antineoplastic medication price increases.

Abstract

6592 Background: Established antineoplastic medication prices are overall increasing, yet the yearly trend and additive cost of such increases relative to overall antineoplastic spending is often unclear. Methods: We accessed the yearly reimbursement files from Medicare Part B for parenteral antineoplastic agents (codes J8501-J9999) for the years 2010-2020 and adjusted all values to 2020 USD to account for inflation. We calculated an initial inflation-adjusted price-per-claim for every medication at the time of medication entry to the database and compared that price with the yearly price-per-claim that Medicare reimbursed. For medications whose price had increased beyond the initial inflation-adjusted price, we multiplied the annual differences with the total annual claims of the medication reimbursed in order to calculate the additional cost accrued by Medicare for every affected year. We only included medications with total annual cost >10 million USD/yr in our analysis. Results: Price increases were noted in 70.9% of already established medications annually (median 74.5%, range 52.17-81.48%). This led to an average additional extra cost of 311 million USD (range 156-492 million USD) annually, for a total of 3.1 billion USD over the 10 years of observation. This extra cost represented 4.6-9.3% of the total Medicare Part B spending for antineoplastic medications annually and this percentage rose yearly by a statistically significant 0.43% (95% CI 0.14%-0.73%, P = 0.01; R2 0.59) in absolute terms (Table). Rituximab (1,003 million USD), trastuzumab (421 million USD), and bevacizumab (326 million USD) accumulated the highest extra costs. Conclusions: The majority of established parenteral antineoplastics are affected by escalating price increases beyond the rate of inflation. Year-by-year, these increases occupy a progressively larger part of overall Medicare Part B spending. Since Medicare does not negotiate medication price nor receives rebates but rather relies on average market prices, these increases likely affect other U.S. markets as well.[Table: see text]