Medicare beneficiaries could save between $228.1 million and $2.15 billion per year if insurers operating the U.S. government's Medicare Part D plans purchased seven generic oncology drugs at the same prices obtained by the Mark Cuban Cost Plus Drug Company (MCCPDC), according to a new study published by Cortese et al in the Journal of Clinical Oncology.
Background
Founded in January 2022 by U.S. businessman and investor Mark Cuban and radiologist Alexander Oshmyansky, MD, PhD, MCCPDC currently sells hundreds of generic drugs using a cost plus 15% pricing strategy, a $3 pharmacy fee, and a $5 maximum shipping cost for 30-day, 60-day, or 90-day prescriptions.
“Both [physicians] and patients should be aware of cash-pay options available that might offer lower prices to beneficiaries purchasing outside of their health plans and the impact that this drug price stewardship could have on Medicare and Part D sponsors,” explained senior study author Ruchika Talwar, MD, a urologic oncology fellow in the Department of Urology at the Vanderbilt University Medical Center. “These findings are of utmost importance,” he stressed.
In a previous study—published by Cortese et al in The Journal of Urology—investigators examined cost savings by purchasing through the MCCPDC and estimated that patients could save $1.29 billion per year based on 2020 Medicare Part D expenditures for the nine most popular urologic drugs.
Study Methods and Results
In the new study, the investigators estimated the potential savings that could be observed by switching to MCCPDC prices with the implication that Medicare Part D plan sponsors and beneficiaries were likely overpaying for self-administered generic oncology drugs.
They first obtained public formulary data from MCCPDC that identified the seven generic oral oncology drugs offered by the company—abiraterone, anastrozole, imatinib (100 mg and 400 mg), letrozole, methotrexate, raloxifene, and tamoxifen—their dosages, and associated prices offered in December 2022. The investigators discovered a potential savings of $661.8 million (78.8%) if median Medicare Part D unit prices were replaced by MCCPDC prices.
The total savings ranged from $228.1 million (56.1%) to $2.15 billion (92.4%) when assuming plan prices were equal to the 25th or 75th percentiles of 2022 quarter three Part D plan unit prices.
The investigators calculated the price differences between typical drug costs and those purchased with MCCPDC. They noted that abiraterone—which is used in combination with prednisone to treat metastatic prostate cancer—had a median cash-pay price at $562.49 vs $44.60 with a 30-day prescription offered under the MCCPDC model. Similarly, the median price for the tyrosine kinase inhibitor imatinib was $442.32 for 100 mg and $1,480.29 for 400 mg vs $44.0 when purchased under the MCCPDC model.
“The MCCPDC is one of several companies that aim to address a real problem for consumers—the costs of generic drugs,” emphasized co–study author Stacie Dusetzina, PhD, the Ingram Professor of Cancer Research and Professor of Health Policy at the Vanderbilt University Medical Center. “This study highlights that, in some cases, Part D plans and their pharmacy benefits managers aren’t doing a good enough job at getting favorable prices for generic drugs for Medicare and its beneficiaries. In some cases, we find that Medicare beneficiaries would overpay by a lot if they used their Medicare benefit to fill one of these cancer drugs. That shouldn’t happen,” she underscored.
When compared with the median cash-pay prices under 2022 quarter three for Medicare Part D plans, the prices of other medications for 30-day prescriptions under the MCCPDC model were $10.70 vs $11.18 for anastrozole, $10.70 vs $12.02 for letrozole, $15.80 vs $23.75 for methotrexate, $11.60 vs $44.55 for raloxifene, and $14.90 vs $17.94 for tamoxifen.
The median savings for each drug using Part D plan unit prices were: abiraterone $338.0 million [$143.2 million to $1,032.2 million], anastrozole $1.2 million [–$13.7 million to $23.2 million], imatinib 100 mg $15.6 million [$5.2 million to $67.4 million], imatinib 400 mg $212.0 million [$70.4 million to $866.6 million], letrozole $1.9 million [–$4.6 million to $10.1 million], methotrexate $26.7 million [$5.0 million to $61.1 million], raloxifene $63.8 million [$26.9 million to $85.3 million], and tamoxifen $2.6 million [–$4.2 million to $8.6 million].
Conclusions
The investigators hope their new findings inspire future studies that continue to spread awareness to patients and physicians about MCCPDC, potentially ease the burden of financial toxicity, and improve access to essential cancer medications.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
