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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.

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MouseDoctor

3 comments

  • Just got out my Daily Glatopa shot to warm up.
    I keep hearing how it’s become old school or Lower Efficacy (ouch, That hurt 😔)
    It’s been my go to since 2007 when I was randomized to Copaxone in he CombiRx Trial.
    I knew 3 times a week just wouldn’t work. I need Daily to remember and to get the nerve to give myself a stinger and a welt. My upper arms are cavitated. I don’t use them anymore.
    I was given a prescription for Glatopa as soon as it went Generic.
    Guess What? My Copay Assistance Vanished. Poof!
    I Tried to get back on Copaxone because I didn’t want to pay so much.
    I couldn’t.
    So I don’t know who the slowpokes were but that may have been a factor.
    Pharma is all powerful. Nothing worth taking is free.

  • The overall spending on Copaxone and Glatiramer generics is falling in the US and probably worldwide, not only because of competition. But, because many people have stopped taking this DMT and/or have switched to alternative medicines.

    Cost per patient ? Who Knows ?

    Almost nobody knows the real cost of drugs like this in the US. The insurance companies are acting like middlemen in the marketplace, and this reduces cost transparency. Those without insurance often are eligible for subsidies from the drug companies or their subsidiaries.

    • Hello,
      I can explain how much a drug will cost Insurance in the USA. My insurance company paid $72,000 dollars for 3 doses of Lemtrada in March 2020. If I remember correctly the Pharmacy billed the insurance $75,000 but only received $72K. Lemtrada Round 1 cost insurance $ 115K for 5 doses in March 2019. The AWP=Average wholesale price is public information in the USA, insurance typically pays the AWP price which is not good business for pharmacists. The profit margin is almost nothing now. Nevertheless, the pharmacists lost control of their profession in the late 1980’s early 1990’s when we allowed Insurance and the PBM’s= pharmacy benefit manager (PBM work on every angle to take from the pharmacist pie, pharmacist got screwed big time) into their pharmacy business, why? ignorance. Now Pharmacists in the USA have lost their profession, profits are almost zero. Another reason prices escalated in the USA since the 1990’s, the drug prices were hidden behind patient copay amounts. How do I know, I am a Pharmacist since early 1990’s, a front row seat watching the all non-sense. All the patient wants to know typically is how much is the drug copay. Ugh……

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