Affordability Of Drug Treatment In Advanced Non-Small Cell Lung Cancer.

e18619 Background: Novel treatments have been approved for advanced non-small cell lung cancer (NSCLC) to improve patient outcomes; however, their high costs could pose significant barriers to their widespread use. We examined changes in drug-specific prices in Medicare from 2010 to 2017 to provide insights into drug affordability in advanced NSCLC for products covered on the medical benefit (Part B) and on the outpatient prescription drug benefit (Part D). Methods: We used the Prescription Drug Pricing file and the Average Sales Price data from the Centers for Medicare & Medicaid Services to obtain price information for Part D (oral drugs) and Part B (mostly infused drugs) drugs, respectively. We identified median point-of-sale drug prices for each drug and year and calculated expected out-of-pocket costs for each drug using the standard Part D benefit design in 2017 or assuming a 20% coinsurance for Part B. Results: Over time higher entry prices at FDA approval were observed for drugs covered under Part D, from $2,293/month in 2010 to $14,079/month in 2017. Older drugs covered under Part D also experienced considerable price hikes (up to 244%). In contrast, Part B drug prices have remained stable over time. Over the study period traditional chemotherapies were priced below $100/month; products with new formulations (e.g., albumin-bound paclitaxel) or newer chemotherapy agents (e.g., pemetrexed) were $8,000/month or more. Prices for novel targeted therapies were high on both Part B and Part D; > $10,000/month (immunotherapy, Part B), $8,000/month (EGFR-targeted agents, Part D), and > $13,000/month (ALK-targeted therapy, Part D). In 2017, expected patient out-of-pocket spending was estimated to range from < $40-$3,000/month for a Part B drug and $1,800-$3,500/month for a Part D drug. Conclusions: Treatment affordability is likely to present continued challenges for advanced NSCLC patients given current plan benefits and ever-increasing drug prices. A sustainable mechanism to control/monitor drug price (e.g., value-based pricing) and provide financial access to these medications is needed to ensure optimal patient outcomes.