ProfG has been asking questions about the prescribing habits of his colleagues and asks why alemtuzumab and HSCT are not being used by some. I wonder if the other end of the spectrum will be questioned and the use of lower efficacy agents. This is going strong
Rome BN, Tessema FA, Kesselheim AS. US Spending Associated With Transition From Daily to 3-Times-Weekly Glatiramer Acetate [published online ahead of print, 2020 Jul 20]. JAMA Intern Med. 2020;10.1001/jamainternmed.2020.2771. doi:10.1001/jamainternmed.2020.2771
Importance: Market exclusivity for daily injections of glatiramer acetate, a disease-modifying therapy for multiple sclerosis, expired in 2015. In 2014, the manufacturer launched an alternate 3-times-weekly version that was widely adopted, sustaining market dominance of brand-name glatiramer until late 2017.
Objective: To estimate excess US spending associated with the transition from daily to 3-times-weekly glatiramer.
Results: From 2011 to 2015, US glatiramer spending increased to $962 million per quarter and did not decrease with generic competition of only daily glatiramer (2015-2017). After generic competition began for 3-times-weekly glatiramer in 2017, prices decreased by 47% to 64%, and spending decreased to $508 million per quarter in 2019 (P < .001 for slope). The delay in decreased spending from 2015 to 2017 was associated with excess spending of $4.3 billion to $6.5 billion.
Conclusions and relevance: These findings suggest that 2.5 years of delayed generic competition related to introduction of a new version of branded glatiramer acetate was associated with $4.3 billion to $6.5 billion in excess spending. Extended market exclusivity from introducing a new version of an existing brand-name drug can yield manufacturer returns out of proportion to the level of investment or risk involved; more limited incentives could encourage incremental innovations to existing drugs at a lower societal cost.