Trends in List and Net Prices of Self-administered Systemic Psoriasis Therapies Manufactured by US-Based Pharmaceutical Companies | Dermatology | JAMA Dermatology | JAMA Network
[Skip to Navigation]
Sign In
Figure.  Changes in Annual Treatment Costs for Medications, Calculated Based on List Prices and Net Prices and the FDA-Approved Dosing Regimen for a Standard 80-kg Patient With Psoriasis
Changes in Annual Treatment Costs for Medications, Calculated Based on List Prices and Net Prices and the FDA-Approved Dosing Regimen for a Standard 80-kg Patient With Psoriasis

Annual treatment costs were adjusted for inflation using the consumer price index and adjusted to the value of the USD in 2009. Net prices are net of all concessions made by manufacturers including rebates, coupon cards, 340B discounts, prompt pay discounts, return provisions, and any other deductions captured in the reporting of net sales. FDA indicates the US Food and Drug Administration; USD, United States dollar.

Table.  Summary List Price, Net Price, and Discount Data for Initial Year of Therapy for an 80-kg Patient for Self-administered Systemic Psoriasis Therapies
Summary List Price, Net Price, and Discount Data for Initial Year of Therapy for an 80-kg Patient for Self-administered Systemic Psoriasis Therapies
1.
Cheng  J, Feldman  SR.  The cost of biologics for psoriasis is increasing.   Drugs Context. 2014;3:212266. doi:10.7573/dic.212266 PubMedGoogle Scholar
2.
SSR Health. SSR Health LLC is the leader in US prescription brand drug pricing data and analytics. Accessed April 17, 2020. https://www.ssrhealth.com/
3.
Hernandez  I, San-Juan-Rodriguez  A, Good  CB, Gellad  WF.  Changes in list prices, net prices, and discounts for branded drugs in the US, 2007-2018.   JAMA. 2020;323(9):854-862. doi:10.1001/jama.2020.1012PubMedGoogle ScholarCrossref
4.
Drugs@FDA: FDA-approved drugs. US Department of Health and Human Services. Accessed April 20, 2020. https://www.accessdata.fda.gov/scripts/cder/daf/
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Views 967
    Citations 0
    Research Letter
    August 12, 2020

    Trends in List and Net Prices of Self-administered Systemic Psoriasis Therapies Manufactured by US-Based Pharmaceutical Companies

    Author Affiliations
    • 1Department of Dermatology, University of Pittsburgh, Pennsylvania
    • 2Division of General Internal Medicine, University of Pittsburgh, Pennsylvania
    • 3Department of Pharmacy and Therapeutics, University of Pittsburgh, Pennsylvania
    JAMA Dermatol. 2020;156(10):1136-1138. doi:10.1001/jamadermatol.2020.2685

    Systemic psoriasis therapies are among the costliest drugs prescribed by dermatologists, and list prices of many of these drugs have increased over time.1 However, list price alone gives an incomplete picture of true treatment costs, as pharmaceutical companies provide discounts to payers (rebates) and other offsets, such as copay assistance, which affect the net price of these drugs. We describe 2009 to 2019 trends in list and net prices for self-administered psoriasis therapies manufactured by companies publicly traded in the United States.

    Methods

    We obtained 2007 to 2019 list and net price data from the investment firm SSR Health for self-administered psoriasis therapies available in the United States by January 1, 2019 (Table).2 This study was not subject to institutional review board review because no human data were used.

    SSR Health estimates net prices for branded drugs manufactured by publicly traded companies using company-reported sales and number of units sold each quarter across the United States. Net prices account for all manufacturer discounts, including rebates to payers, coupon cards, 340B discounts (discounted prices to organizations caring for low-income and vulnerable patients), and any other concession accounted for in the reporting of sales. The robustness of SSR Health data in estimating net prices for prescription drugs has been demonstrated in peer-reviewed research.3 Net pricing for tildrakizumab was not available as it is manufactured by a nonpublicly traded manufacturer.

    For each drug and year, we calculated average list (wholesale acquisition) and net costs of psoriasis treatment for the initial year of therapy for an 80-kg patient based on US Food and Drug Administration–approved recommended dosing. We adjusted prices by inflation using the consumer price index. All prices are shown adjusted to the value of the US dollar in 2009.

    Results

    For all drugs studied, list prices increased substantially over time, with the greatest increase observed for tumor necrosis factor inhibitors, which increased by approximately 200% from 2009 to 2019 (annual mean change for etanercept, 12%; adalimumab, 12%; and certolizumab, 10%). Although net prices steadily increased until 2016, they began to decrease for ustekinumab in 2016, secukinumab and guselkumab in 2017, and brodalumab, adalimumab, and certolizumab in 2018 (Figure).

    As of 2019, there was a large (30%-59%) and widening gap between list and net prices because of increasing discounts. The list price was highest for certolizumab ($94 379), followed by the interleukin (IL)-17A inhibitors secukinumab ($77 883) and ixekizumab ($75 848), and lowest for the oral phosphodiesterase-4 inhibitor apremilast ($34 545); net price was highest for the 3 tumor necrosis factor inhibitors (certolizumab, $48 193; etanercept, $43 910; and adalimumab, $39 751) and lowest for the IL-17–receptor inhibitor brodalumab ($17 692) (Table).

    Discussion

    We identified substantial price increases from 2009 to 2019 for self-administered psoriasis therapies. Even after accounting for inflation and discounts, the net price of some therapies more than doubled, highlighting the financial burden on payers and patients for these therapies.

    Although insurers may benefit from lower net prices because of the ability to negotiate for discounts for formulary placement, patients’ out-of-pocket expenses are often based on list prices. High-deductible plans use list prices to calculate patients’ financial responsibility, making these therapies unobtainable for some patients. In addition, we observed that a decrease in net price for incumbent products coincided with the US Food and Drug Administration approval dates of novel therapies, including ixekizumab in 2016, brodalumab and guselkumab in 2017, and certolizumab for the indication of psoriasis in 2018.4 This suggests that competition from entry of new branded products may lead to discounts that primarily benefit payers rather than benefiting uninsured and underinsured patients who pay based on the list price. Interestingly, net prices for tumor necrosis factor inhibitors, which are used across multiple indications, did not decrease similarly. Limitations of this study include the use of aggregated data, which precludes estimating to what extent discounts are due to rebates to payers, discounts to patients (eg, such copay or drug cost assistance), or other concessions. Our work has implications for future research, as net price, along with drug safety and efficacy data, would be useful for more accurately evaluating the cost-effectiveness of psoriasis treatments.

    Back to top
    Article Information

    Accepted for Publication: May 29, 2020.

    Corresponding Author: Laura K. Ferris, MD, PhD, Department of Dermatology, University of Pittsburgh, 3708 Fifth Ave, Pittsburgh, PA 15213 (ferrislk@upmc.edu).

    Published Online: August 12, 2020. doi:10.1001/jamadermatol.2020.2685

    Author Contributions: Dr Hernandez had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: All authors.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Ferris, Hernandez.

    Critical revision of the manuscript for important intellectual content: Gellad, Hernandez.

    Statistical analysis: Hernandez.

    Administrative, technical, or material support: All authors.

    Supervision: Ferris.

    Conflict of Interest Disclosures: Dr Hernandez reported receiving personal fees from Pfizer outside the submitted work. Dr Ferris reported receiving personal fees from Pfizer, Eli Lilly and Company, Bristol-Myers Squibb, and Janssen Pharmaceutica and grants from Amgen, AbbVie Inc, Eli Lilly and Company, Janssen Pharmaceutica, Bristol-Myers Squibb, Celgene, UCB (Union Chimique Belge), Dermavant Sciences Ltd, Arcutis Biotherapeutics, Novartis, GlaxoSmithKlein, Sandoz, Boerhinger Ingelheim, Sienna Biopharmaceuticals, and LEO Pharma outside the submitted work. No other disclosures were reported.

    Funding/Support: This study was supported in part by grant K01HL142847 from the National Heart, Lung and Blood Institute (Dr Hernandez).

    Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    References
    1.
    Cheng  J, Feldman  SR.  The cost of biologics for psoriasis is increasing.   Drugs Context. 2014;3:212266. doi:10.7573/dic.212266 PubMedGoogle Scholar
    2.
    SSR Health. SSR Health LLC is the leader in US prescription brand drug pricing data and analytics. Accessed April 17, 2020. https://www.ssrhealth.com/
    3.
    Hernandez  I, San-Juan-Rodriguez  A, Good  CB, Gellad  WF.  Changes in list prices, net prices, and discounts for branded drugs in the US, 2007-2018.   JAMA. 2020;323(9):854-862. doi:10.1001/jama.2020.1012PubMedGoogle ScholarCrossref
    4.
    Drugs@FDA: FDA-approved drugs. US Department of Health and Human Services. Accessed April 20, 2020. https://www.accessdata.fda.gov/scripts/cder/daf/
    ×