The first cancer drug to reach “blockbuster” status with sales of more than $1 billion was paclitaxel in 1997. Twenty years later, the median annual cost of a new cancer drug launched in 2017 exceeded $150,000, compared to $79,000 for the new cancer drugs launched in 2013, according to a report issued last year by IQVIA™ Institute for Human Data Science.
IQVIA’s report, “Global Oncology Drug Trends 2018,” showed that in the U.S., spending on cancer treatments had doubled since 2012, reaching almost $50 billion in 2017—compared with $60 billion in oncology drug costs in the rest of the world. Two thirds of the jump in U.S. cancer drug sales came from treatments launched within the previous five years, with 14 new cancer therapeutics launched in 2017 alone.
Even more sobering, IQVIA projected that U.S. cancer drug prices are expected to double again by 2022, to $100 billion, based on annual growth of 12–15%. An equivalent amount of sales is also forecast outside the U.S., where sales are expected to grow at a slightly smaller pace of between 10% and 13% annually. As a result, the global cancer drug market is projected to reach $200 billion in three years.
The challenge of containing the cost of cancer drugs was cited by panelists at “Advancing Quality Oncology Care In the Evolving Value-Based Care Landscape,” a panel discussion held April 16 in White Plains, NY, by The American Journal of Managed Care® (AJMC®) with its Institute for Value-Based Medicine®.
Manuel C. Perry, MD, director, oncology care model division leader, hematology/oncology, Crystal Run Healthcare, cited as a barrier “the amount of hoops that our practice and every other practice has to jump through that is not reimbursed, in order to get patients free drugs because $18,000 a month is impossible.
“Pharmacy benefit managers need to have better controls. Drug companies need to have better controls. We don’t want to thwart innovation, but we need to have access,” Perry said. “If the government can’t negotiate with a drug company, there needs to be some other cost-containment strategy. You can’t have no cost containment, and no [value-based] pathways, and no consequences. Something needs to happen. You have to chose one. You have to choose another. Maybe it’s a blend. I don’t know what the answer is. But what we have right now is unsustainable.”
“I think we all agree that the escalating costs are unsustainable,” added the panel’s moderator, Shalom Kalnicki, MD, chairman, department of radiation oncology, Albert Einstein College of Medicine and Montefiore Medical Center.
Below is GEN’s Top 10 A-List of top-selling prescription drugs with cancer indications. The drug that topped this list ranked third on GEN’s A-List of Top 15 Best-Selling Drugs of 2018, which included more than half of the cancer drugs that generated sufficient sales to be ranked here.
Top-selling drugs are ranked based on sales or revenue reported for 2018 by bio/pharma companies in press announcements, annual reports, investor materials, and/or conference calls. Each drug is listed by name, sponsor(s), type of drug, 2018 sales, 2017 sales, and the percentage change between both years.
The top 10-selling cancer drugs generated a combined $63.58 billion in sales in 2018, up 17.5% from $54.126 billion in 2017. Seven of this year’s top 10 showed year-over-year increases in sales, of which six enjoyed double-digit gains.
Ranking #15 through #11 among cancer best-sellers are Takeda/Johnson & Johnson’s Velcade® (bortezomib); Incyte/Novartis’ Jakafi®/Jakavi® (ruxolitinib); Genentech (Roche)’s Perjeta (pertuzumab); Merck & Co.’s Gardasil/Gardasil 9; and J&J’s Zytiga® (abiraterone acetate). The treatments generated between $2.274 billion and $3.498 billion last year.
10. Xtandi® (enzalutamide)
Astellas Pharma and Pfizer
Type of Drug: Androgen receptor inhibitor
2018 Sales: $3.624 billion (¥327.8 billion [$2.925 billion Astellas + $0.699 billion Pfizer)
2017 Sales: $3.116 billion (¥282.8 billion [$2.526 billion Astellas + $0.590 billion Pfizer)
% Change: 16.3%
9. Ibrance® (palbociclib)
Type of Drug: Kinase inhibitor
2018 Sales: $4.118 billion 1
2017 Sales: $3.126 billion 1
% Change: 31.7%
8. Neulasta/Peglasta (pegfilgrastim)
Amgen and Kyowa Hakko Kirin
Type of Drug: Leukocyte growth factor
2018 Sales: $4.684 billion ($4.475 billion Amgen + $0.209 billion [¥23.1 billion] Kyowa Hakko Kirin)
2017 Sales: $4.716 billion ($4.534 billion Amgen + $0.182 billion [¥20.1 billion] Kyowa Hakko Kirin)
% Change: -0.7%
7. Imbruvica® (ibrutinib)
Pharmacyclics (AbbVie) and Johnson & Johnson (J&J)
Type of Drug: Kinase inhibitor
2018 Sales: $6.205 billion ($3.590 billion Pharmacyclics [AbbVie] + $2.615 billion J&J)
2017 Sales: $4.466 billion ($2.573 billion Pharmacyclics [AbbVie] + $1.893 billion J&J)
% Change: 38.9%
6. Rituxan®/MabThera (rituximab)
Genentech (Roche) and Biogen 2
Type of Drug: CD20-directed cytolytic antibody
2018 Sales: $6.750 billion [CHF 6.752 billion] 2
2017 Sales: $7.298 billion [CHF 7.300 billion] 2
% Change: -7.5%
Type of Drug: Vascular endothelial growth factor–directed antibody
2018 Sales: $6.822 billion (CHF 6.849 billion)
2017 Sales: $6.662 billion (CHF 6.688 billion)
% Change: 2.4%
Type of Drug: HER2/neu receptor antagonist
2018 Sales: $6.951 billion (CHF 6.982 billion)
2017 Sales: $6.983 billion (CHF 7.014 billion)
% Change: -0.5%
Merck & Co.
Type of Drug: Programmed death receptor-1 (PD-1)-blocking antibody
2018 Sales: $7.171 billion
2017 Sales: $3.809 billion
% Change: 88.3%
Bristol-Myers Squibb (BMS) and Ono Pharmaceutical
Type of Drug: Programmed death receptor-1 (PD-1) blocking antibody
2018 Sales: $7.570 billion ($6.735 billion BMS + $835 million [¥92.5 billion] Ono)
2017 Sales: $5.763 billion ($4.948 billion BMS + $815 million [¥90.2 billion] Ono)
% Change: 31.4%
Type of Drug: Thalidomide analogue
2018 Sales: $9.685 billion
2017 Sales: $8.187 billion
% Change: 18.3%
1. Despite the year-over-year sales increase, Pfizer said international Ibrance revenues were negatively impacted by a one-time price adjustment to full-year 2017 revenues related to finalizing reimbursement agreements in certain developed Europe markets
2. Biogen receives a share of U.S. pre-tax profits on sales of Rituxan, which is marketed by Genentech (Roche). Sales figures do not include U.S. pre-tax profits generated by Biogen, since the company only discloses those profits combined with profits from Gazyva® (obinutuzumab), and does not break out each product separately. Biogen reported combined Rituxan-Gazyva pre-tax profits of $1.432 billion for 2018, and $1.316 billion for 2017.