Cancer drugs emerging as top driver of specialty drug spending

Cancer treatments are on track to become the biggest driver of specialty pharmacy spending as its contribution to overall drug spending hit 5%for the first time in the first half of 2009, according to USA-based Medco Health Solutions.

Oncology specialty drug spending increased 15.1% last year, trailing only medications for autoimmune conditions and multiple sclerosis as a specialty drug growth driver. Driven by products that can cost tens of thousands of dollars per course of therapy and a deep pipeline of new targeted products with fewer side effects than traditional chemotherapy, worldwide sales of these medications are expected to reach $80 billion by 2012.

High cost of treatment

"Targeted cancer therapies have dramatically reshaped oncology and greatly benefited cancer patients," said Robert Epstein, Medco's chief medical officer. "The newer cancer drugs improve survival rates since they target what fuels the cancer's growth. As some may extend life, they may be used for longer periods of time and improve quality of life for millions of patients. Due to the higher costs of these treatments, however, proper selection and dosing is extremely important," he noted.

Combinations of oral oncology drugs and injectable monoclonal antibodies from the biotechnology industry are big drivers of drug spending and this trend is likely to continue as existing treatments gain additional approvals and new drugs reach the market.

Presently, more than 800 drugs are under investigation for treatment of cancer, which is expected to be diagnosed 1.48 million times this year. Early detection and more effective, well-tolerated medications are allowing some cancers to behave like chronic diseases. According to the American Cancer Society, cancer patients today are living longer than a generation ago with the five-year relative survival rate for all cancers combined between 1996-2004 reaching 66%, up from 50% between 1975-77.

Nearly all the cancer drugs approved by the US Food and Drug Administration in the last four years have cost more than $20,000 for a 12-week course of therapy, while some individual treatments can cost $10,000 per month. Oncology drugs are projected to account for 9% of all prescription pharmaceutical spending growth between 2009 and 2011, says Medco.

To help manage the drug spend in the biotech drug category, in which many of the cancer treatments reside, a regulatory pathway to make lower-cost, generic versions - biosimilars - of these drugs is now under consideration in Congress. If approved, generic biotech drugs could lead to significant savings once the original brand drug loses patent.

Breast cancer drugs to hit market

Many oncology agents in late-stage clinical development and several expected to receive approval in 2010 or 2011 will likely have a significant effect on specialty drug spending. Breast cancer could have an array of new treatments, including vandetanib (AstraZeneca's Zactima), motesanib, lonafarnib (Schering-Plough's Sarasar) and GlaxoSmithKline's pazopanib. Several of these drugs may be initially approved for other forms of cancer, Medco notes.