Last week, two drug companies that jointly sell a blood-cancer drug made a rare decision: to not move forward with changes that would have effectively tripled the cost of a lifesaving medicine for some patients.
Most patients take three capsules of Imbruvica a day, at an annual price of $148,000 - most of which is picked up by insurance. But just as early evidence began to suggest a lower dose might be effective, Janssen and Pharmacyclics announced they were discontinuing the old capsule and introducing once-a-day tablets in four different dosages.
The new pills were all the same, flat price of $400 - or triple the cost of the original capsule. Patients who had been taking one or two pills a day would see higher costs, and even if future evidence supported the use of lower doses of the drug, patients, insurers and health systems would not save money.
Oncologists were critical of the changes, and last week, Janssen and Pharmacyclics announced they were reversing course. They will keep the original, 140 milligram capsule on the market - at the original price.
"We have received feedback regarding the availability of Imbruvica capsules, and as a result will continue to offer 140 mg Imbruvica capsules as an option in addition to our one pill, once-a-day tablet," Pharmacyclics, which is owned by the drug giant AbbVie, said in a statement.
Physicians, who say they frequently adjust the dose of Imbruvica to avoid interactions with other drugs or side effects, had been concerned the dosing change could delay their ability to rapidly change patients' dosages as needed. While the once-a-day tablet was described as an innovation to increase patients' adherence to the drug for those challenged by having to take three pills at a time, physicians said the price of a drug was more often a deterrent.
Doctors also saw the dosing and pricing changes as a way to guard against emerging evidence, in a small pilot study conducted by researchers at MD Anderson Cancer Center, that lower doses of the drug could be effective in patients with chronic lymphocytic leukemia. The Value in Cancer Care Consortium, a nonprofit focused on lowering the cost of cancer treatment, had been planning a clinical trial to more rigorously test lower doses.
"If they're really preserving the status quo, that's fantastic," said Mark J. Ratain, an oncologist at the University of Chicago Medicine who wrote about the issue in the Cancer Letter, a publication read by oncologists. "I appreciate the fact the company is receptive to concerns about not only pricing, but [also] the safety and efficacy."
The announcement came as the Trump administration unveiled its plan to lower drug prices. In a speech Monday, Health and Human Services Secretary Alex Azar warned that in addition to policy levers the administration plans to use, President Donald Trump may use the bully pulpit.
"I can imagine he is going to be very interested in the next company that takes a price increase not justified by inflation or change in clinical benefit," said Azar, a former executive at Eli Lilly. "I can tell you I wouldn't have wanted to be the one to do that."