Drug Price Forecast highlights - January 2019 - Vizient
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Drug Price Forecast highlights January 2019
Executive summary
Projected inflation rate
The Drug Price Forecast is our best estimate of the change in the cost of
pharmaceuticals that participants in the Vizient Pharmacy Program will
be purchasing from July 1, 2019-June 30, 2020. The forecast focuses on
pharmaceutical products used across multiple health-system settings,
4.28%
Weighted by Vizient member purchases. All classes of
including inpatient and non-acute environments, and provides a year-over- trade; excludes 340B purchases.
year estimate of the expected price change.
Highest-spend therapeutic classes for Vizient members Highest-spend drugs for Vizient members
Therapeutic category Key products in class Top 10 drugs by total spend
Antineoplastic agents Rituxan, Keytruda, Avastin Adalimumab (Humira) Alteplase (Activase)
Disease-modifying antirheumatic agents Remicade, Humira, Enbrel Infliximab (Remicade) Pembrolizumab (Keytruda)
Immunomodulatory agents Tysabri, Copaxone, Ocrevus Rituximab (Rituxan) Denosumab (Prolia/Xgeva)
Anti-infectives Harvoni, Epclusa, Zepatier, Cubicin, Pegfilgrastim (Neulasta) Nivolumab (Opdivo)
Invanz, Noxafil
Etanercept (Enbrel) Ustekinumab (Stelara)
Plasma critical care Gamunex, Privigen, Gammaguard, AlbuRx,
Albutein, Flexbumin
Top 10 drugs by size of projected price increase
Hematopoietic agents Neulasta, Aranesp, Procrit
Adalimumab (Humira) Vasopressin (Vasostrict)
Vaccines Prevnar, Gardasil, Pneumovax
Etanercept (Enbrel) Vedolizumab (Entyvio)
Denosumab (Prolia/Xgeva) Pneumococcal 13-valent conjugate vaccine
(Prevnar 13)
Usetekinumab (Stelara) Abatacept (Orencia)
Alteplase (Activase, Cathflo Activase) Octreotide (Sandostatin LAR Depot)
Positive developments Ongoing challenges Our advice
• 16 biosimilars approved; steps taken to promote uptake • Balancing product control and patient needs for opioids • Adopt biosimilars
• Increased competition for small-molecule drugs • All-time high new drug prices • Manage specialty pharmacy across your enterprise
• Pending federal recommendations for lowering drug costs • Reduced disproportionate share hospital payments • Take part in Vizient programs to support advocacy
To download the Drug Price Forecast, visit vizientinc.com/
Our-solutions/Pharmacy-Solutions/Drug-Price-Forecast-public.
January 2019 Vizient Drug Price ForecastTimelines and approvals New drug approvals Regulatory events
Generic/biosimilar
availability a
January 2019–June 2020
Ruxolitinib Ravulizumab Siponimod (BAF312) Meloxicam IV Iclaprim Esketamine
Graft-vs.-host disease Paroxysmal nocturnal SPMS Moderate to severe ABSSSI/HABP Depression
Q1 2019 hemoglobinuria Mar 2019 pain, including Q2 2019 May 4, 2019
Feb 18, 2019 postoperative pain
Biosimilar trastuzumab Ozanimod (RPC1063) RI-002 (IgIV) Sacituzumab govitecan
Mar 24, 2019
(PF-0528001) Tagraxofusp RRMS RSV in patients with primary Metastatic breast cancer
HER2-positive AML Mar 2019 Fosphenytoin, immune deficiency disease May 21, 2019
breast/gastric cancer Feb 21, 2019 captisol enabled Apr 2, 2019
Herceptin SQ Biosimilar bevacizumab
Feb 2019 Seizures
N8-GP (turoctocog Breast cancer Selinexor (PF-06439535)
Mar 30, 2019
Iclaprim alfa pegol) Mar 2019 Multiple myeloma Nonsquamous NSCLC
ABSSSI Hemophilia A Apr 6, 2019 Jun 2019
Sotagliflozin
Feb 13, 2019 Feb 27, 2019
Type 1 diabetes Risankinzumab AXVS-101
Mar 22, 2019 Moderate to severe plaque SMA type 1
psoriasis Jun 18, 2019
Apr 25, 2019
CMS MACRA CMS Conditions of Participation for Long-Term Care:
Performance measures (MIPS) enforced Jan 1, 2017 Antibiotic Stewardship Program implementation
Jan 2019 Deadline extended to have antibiotic stewardship program in
place. Reimbursement penalties go into effect May 2019.
2019 Q1 Q2
Minocycline Azithromycin Fulvestrant Fosaprepitant Solifenacin succinate Atazanavir
Solodyn (ophthalmic) Faslodex dimeglumine Vesicare Reyataz (oral powder)
Feb 2019 AzaSite Mar 2019 Emend Apr 2019 Jun 2019
Mar 31, 2019 Mar 2019
a
Projected dates of loss of exclusivity for originator drugs and generic or biosimilar entrants to the market are subject to change.
Abbreviations: ABSSSI = acute bacterial skin and skin structure infection; AML = acute myeloid leukemia; CABP = community-acquired bacterial pneumonia;
CMS = Centers for Medicare & Medicaid Services; DSCSA = Drug Supply Chain Security Act; HABP = hospital-associated bacterial pneumonia; IgIV = immune globulin,
intravenous; MACRA = Medicare Access and CHIP Reauthorization Act; MDR = multidrug-resistant; MIPS = Merit-based Incentive Payments System; NSCLC = non–small-cell
lung cancer; PDUFA = Prescription Drug User Fee Act; RA = rheumatoid arthritis; RRMS = relapsing-remitting multiple sclerosis; RSV = respiratory syncytial virus;
SMA = spinal muscular atrophy; SPMS = secondary progressive multiple sclerosis; USP = US Pharmacopeia.
January 2019 Vizient Drug Price ForecastTimelines and approvals New drug approvals Regulatory events
Generic/biosimilar
availability a
January 2019–June 2020
Erdafitinib Biosimilar Cefidercol
Bladder cancer adalimumab (SB5) MDR gram-negative organisms
Q3 2019 RA Q4 2019
Jul 2019
Imipenem/relebactam Biosimilar filgrastim (TX-01)
MDR gram-negative Biosimilar rituximab Chemotherapy-induced neutropenia
organisms (PF-05280586) Oct 1, 2019
Q3 2019 Non-Hodgkin’s
lymphoma DSCSA
Lefamulin
Jul 2019 Wholesalers must verify serialized
CABP
Q3 2019 Crenolanib product identifier for saleable returns
AML Nov 27, 2019
Fosfomycin
Aug 31, 2019
MDR gram-negative
organisms USP Chapter
Q3 2019 Effective Dec 1, 2019
USP Chapters , ,
Final versions to be published Jun 1, 2019
Effective Dec 1, 2019
Q3 Q4 2020 Q1 Q2
Thalidomide Hydrocodone bitartrate Carfilzomib Enzalutamide Lenalidomide Apixaban
Thalomid Zohydro ER Kyprolis Xtandi (5, 10, 15, 25 mg) Eliquis 2.5 mg
Aug 1, 2019 Nov 1, 2019 Jan 20, 2020 Feb 29, 2020 Revlimid Jun 28, 2020
Apr 5, 2020
Fosaprepitant dimeglumine Posaconazole Lanreotide acetate
Emend (inj) Noxafil suspension Somatuline Depot Melphalan HCl
Sep 5, 2019 Jan 20, 2020 Mar 8, 2020 Evomela
May 9, 2020
Alvimopan
Entereg
Jan 27, 2020
a
Projected dates of loss of exclusivity for originator drugs and generic or biosimilar entrants to the market are subject to change.
Abbreviations: ABSSSI = acute bacterial skin and skin structure infection; AML = acute myeloid leukemia; CABP = community-acquired bacterial pneumonia;
CMS = Centers for Medicare & Medicaid Services; DSCSA = Drug Supply Chain Security Act; HABP = hospital-associated bacterial pneumonia; IgIV = immune globulin,
intravenous; MACRA = Medicare Access and CHIP Reauthorization Act; MDR = multidrug-resistant; MIPS = Merit-based Incentive Payments System; NSCLC = non–small-cell
lung cancer; PDUFA = Prescription Drug User Fee Act; RA = rheumatoid arthritis; RRMS = relapsing-remitting multiple sclerosis; RSV = respiratory syncytial virus;
SMA = spinal muscular atrophy; SPMS = secondary progressive multiple sclerosis; USP = US Pharmacopeia.
January 2019 Vizient Drug Price ForecastA closer look by segment
Acute and non-acute care Pediatric Specialty pharmaceuticals
Top 10 drugs by member spend
4.14% Pediatric inflation rate
Annual spend by drug type as a percentage of
total U.S. drug spend
Acute care Non-acute care
Top 10 pediatric drugs based on children’s
Rituximab Adalimumab
hospital spend 70%
Percentage of U.S. drug spend
Pegfilgrastim Etanercept 60%
Drug
Alteplase Ustekinumab 50%
Dinutuximab
40%
Infliximab Dimethyl fumarate
Pegaspargase
30%
Pembrolizumab Glatiramer acetate
Infliximab 20%
Nivolumab Fingolimod HCl 10%
Palivizumab
Trastuzumab Ledipasvir/sofosbuvir 0%
Eculizumab
2013 2014 2015 2016 2017
Bevacizumab Secukinumab
Sildenafil Traditional non-orphan drugs
Immune globulin, gamma Apremilast Non-orphan specialty drugs
Asparaginase
(IgG)/Proline/IgA
Orphan drugs
Dornase alfa
Ocrelizumab Abiraterone acetate
Pneumococcal 13-valent conjugate vaccine
IQVIA Institute. Orphan Drugs in the United States: Growth Trends in
Pegfilgrastim Rare Disease Treatments. https://www.iqvia.com/institute/reports/
orphan-drugs-in-the-united-states-growth-trends-in-rare-disease-
treatments. Published October 2018. Accessed October 27, 2018.
Arrows indicate changes in ranking since the July 2018
Drug Price Forecast.
For Vizient members, total inpatient drug spend for The recent approval of Truxima (Celltrion/Teva), the first Total spend on specialty drugs (including orphan and ultra-
September 2017-August 2018 increased by 35.79%. biosimilar for rituximab, the acute care drug that accounts orphan drugs) reached $200 billion in 2017.
for the highest share of Vizient member drug spend, is
expected to have a significant impact on the U.S. market.
January 2019 Vizient Drug Price ForecastKey therapeutic class summaries
Oncology Plasma (IgIV, albumin)
3.10% 3.00%
Period projected inflation rate Period projected inflation rate
Analysis of Vizient Clinical Data Base data shows that the most commonly used
Immunoglobulins from all market suppliers experienced
checkpoint inhibitor is pembrolizumab for lung cancer. CAR-T therapy, which uses
some disruptions in 2018 as manufacturers struggled to
the patient’s own immune cells to combat the cancer cells, also continues to grow.
meet increased demand in 2018. Albumin remains abundant
CMS approved a new technology add-on payment for CAR-T for in fiscal year 2019.
and will likely see price reductions in 2019.
Use of PD-1 and PD-L1 drugs in oncology disease states
36,000
31,500
27,000
No. of cases
22,500
18,000
13,500
9,000
4,500
0
Urothelial Renal cell Melanoma Lung cancer Head/neck
cancer carcinoma cancer
Atezolizumab Avelumab Durvalumab Nivolumab Pembrolizumab
January 2019 Vizient Drug Price ForecastKey therapeutic class summaries
Infectious disease agents
Antibacterials/antifungals Hepatitis C medications Vaccines
1.19% 0.00% 5.64%
Period projected inflation rate Period projected inflation rate Period projected inflation rate
Daptomycin continues to account for the The overall price per course of therapy has A preferential recommendation from the
highest spend among Vizient members, declined substantially as a result of recent CDC for Shingrix over zoster vaccine live is
despite the introduction of a generic moves from manufacturers responding to driving increased utilization of this product.
version in 2016, but has declined as a pressure to lower medication prices.
percentage of overall spend.
Top 10 antibacterials in acute care based Top 10 hepatitis C medications by projected Top 10 noninfluenza vaccines among
on annual spend among Vizient members 2018 annual spend Vizient members
Drug AHFS category Harvoni Daklinza Prevnar Shingrix
Daptomycin Cyclic lipopeptides Epclusa Sovaldi Gardasil 9 Menactra
Vancomycin Glycopeptides Mavyret Viekira XR Pneumovax Proquad
Piperacillin/tazobactam Extended-spectrum penicillins Vosevi Olysio Boostrix Varivax
Ertapenem Carbapenem Zepatier Technivie Engerix B (adult) Adacel
Rifaximin Rifamycin
Data derived from IQVIA SMART database, January to September 2018 Vizient member data for Sep 2017-Aug 2018.
(annualized); https://customerportal.imshealth.com/sites/imsportal.
Ceftaroline 5th-generation cephalosporins
Accessed November 15, 2018.
Meropenem Carbapenem
Aztreonam Monobactam
Cefepime 4th-generation cephalosporins
Ceftazidime/
3rd-generation cephalosporin
avibactam sodium
Vizient member data for Sep 2017-Aug 2018; 340B purchases excluded. January 2019 Vizient Drug Price ForecastKey therapeutic class summaries
Disease-modifying therapies
Immunomodulators Top disease-modifying therapies among Vizient members
4.43% 1 Ocrelizumab 7 Interferon beta-1a/albumin human
Period projected inflation rate 2 Copaxone 8 Interferon beta-1b
3 Natalizumab 9 Glatiramer acetate
Disease-modifying therapies 4 Fingolimod 10 Peginterferon beta-1a
5 Dimethyl fumarate 11 Glatopa
6.97% 6 Interferon beta-1a
Period projected inflation rate Vizient member data for Sep 2017-Aug 2018.
A recent study showed that prices for drugs to treat
rheumatoid arthritis rose 40.1% over three years, and for
multiple sclerosis treatments, 30.6%.1 Rising costs are
prompting exploration of new mechanisms to increase
affordability such as step therapy and “pharmacy tourism,”
now offered by one insurer in Utah.
1 Langreth R, Koons C, Gu J. After raising prices for 100s of drugs, industry
pledges restraint. Bloomberg News. July 16, 2018. https://www.bloomberg.
com/graphics/2018-drug-price-index. Updated August 1, 2018. Accessed
November 8, 2018.
Download the complete
Key Therapeutic Class Summaries January 2019 Vizient Drug Price ForecastHot topics
Biosimilar uptake New Technology Add-on Payments for drugs
New biosimilar products for rituximab, bevacizumab, trastuzumab and pegfilgrastim — Created by the Centers for Medicare & Medicaid Services, the NTAP
whose originators accounted for $14 billion in spend over 12 months — are approved and program is designed to “provide additional payments for cases
either available now or anticipated in 2019. with high costs involving eligible new technologies while preserving
some of the incentives under the average-based payment system.
The biosimilar pipeline has more than doubled between 2013 and 2017. Most experts
The payment mechanism is based on the cost to hospitals for
predict that bevacizumab, trastuzumab and rituximab will each have at least one
the new technology,”1 and may offer opportunities to increase
commercially launched biosimilar by June 2019. Approval of biosimilars currently under
reimbursements.
consideration will increase competition, which, along with continued reimbursement
changes, may encourage greater uptake of biosimilars. 1 New medical services and new technologies. Centers for Medicare & Medicaid Services
website. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/
AcuteInpatientPPS/newtech.html. Updated October 17, 2018. Accessed November 2,
2018.
Approved biosimilars as of November 2018
Filgrastim-sndz (Zarxio) Bevacizumab-awwb (Mvasi) Adalimumab-adaz (Hyrimoz)
Drugs approved for NTAP in fiscal year 2019
Infliximab-dyyb (Inflectra) Trastuzumab-dkst (Ogivri) Pegfilgrastim-cbqv (Udenyca)
Tisagenlecleucel (Kymriah) Andexanet alfa (AndexXa)
Etanercept-szzs (Erelzi) Infliximab-qbtx (Ixifi) Rituximab-abbs (Truxima)
Axicabtagene ciloleucel (Yescarta) Defibrotide (Defitelio)
Adalimumab-atto (Amjevita) Epoetin alfa-epbx (Retacrit) Trastuzumab-pkrb (Herzuma)
Cytarabine/daunorubicin Ustekinumab (Stelara)
Infliximab-abda (Renflexis) Pegfilgrastim-jmdb (Fulphilia) liposomal (Vyxeos)
Adalimumab-adbm (Cyltezo) Filgrastim-aafi (Nivestym) Meropenem/vaborbactam (Vabomere) Bezlotuxumab (Zinplava)
Biosimilar product information. Food and Drug Administration website. https://www.fda.gov/Drugs/ Plazomicin (Zemdri)
DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/TherapeuticBiologicApplications/
Biosimilars/ucm580432.htm. Updated November 5, 2018. Accessed November 21, 2018.
Drug shortages Drug Supply Chain Security Act Focus on the opioid crisis Reasons for rising drug prices
Although they have not again reached the The next phase of the DSCSA, product A recent Vizient survey revealed that nearly Analysis of data for the drug products that
highs reported in 2011, new and ongoing serialization, took effect in November two-thirds of respondents’ organizations account for the top 80 percent of member
drug shortages continue, especially for 2018. Vizient offers resources, including had reallocated resources and increased spend revealed that the reasons behind drug
injectables. The Vizient Novaplus® private- a webinar series, to help pharmacists and investment in opioid management in price increases are complex and may include
label program covers more than 700 National other stakeholders get up to speed on the the previous 12 months. Challenges and response to competition, increased demand
Drug Codes, including drugs on the shortage requirements of the law and how their roles concerns linger, but legislation to support during shortages, sole-source manufacturing
list maintained by the American Society of are affected. health care organizations has been passed and sudden decreases in number of
Health-System Pharmacists. and new treatments are on the horizon. suppliers.
January 2019 Vizient Drug Price ForecastBudget projections process
How close were we?
To evaluate the accuracy of the Drug Price Forecast purchase projections, we evaluated
average drug price inflation estimates from four previous forecasts and compared them with Vizient Pharmacy Program participants also receive:
the overall price change that actually occurred during the forecasted period.
• Projected price changes by therapeutic class and by
On average, our predictions were within 1.3 percentage points of the actual change in price. generic name.
• The Vizient Pharmacy Charter, developed by our Pharmacy
Executive Council. The charter outlines critical issues affecting
9 the delivery of high-quality, cost-effective and clinically
7.9% integrated pharmaceutical care.
8
• A customizable letter to the C-suite from pharmacy that
Price change (%)
6.8% members can use to help communicate today’s drug market
7
6.3% dynamics to their leaders.
6.0%
6 • Access to the Drug Budget Forecast Report, which can be used
6.2% 6.0% to capture the organization’s pharmacy purchases in detail to
5
5.4% support budget planning.
4
4.2%
3
Jul 2015 Jan 2016 Jul 2016 Jan 2017
Forecast publication date a
Estimated change Actual change
a
Projections in each edition of the Drug Price Forecast are for periods six to 18 months after the publication date.
Learn more about the Vizient Pharmacy
Program at vizientinc.com.
January 2019 Vizient Drug Price Forecast290 E. John Carpenter Freeway
Irving, TX 75062
(972) 830-0000
vizientinc.com
As the nation’s largest member-driven health care performance
improvement company, Vizient provides network-powered insights in
To download the Drug Price Forecast, visit the critical areas of clinical, operational, and supply chain performance
and empowers members to deliver exceptional, cost-effective care.
vizientinc.com/Our-solutions/Pharmacy-
Solutions/Drug-Price-Forecast-public.
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