Which drugs might be hit by US Democrats’ pricing proposals?

US drug pricing is set to remain a hot topic ahead of next year’s elections. And now the Democrats have unveiled their plans to lower drug spending, via proposals put forward by House Speaker Nancy Pelosi yesterday. The most eye-catching was probably a scheme to allow the government to directly negotiate prices for drugs covered by Medicare, using overseas costs as a benchmark. The proposals call for direct negotiation for at least 25 drugs, rising to up to 250. It is still not clear which drugs might be included in the plans, which in any case are a long way from becoming reality. But a look at the most expensive drugs covered by Medicare Part D in 2017 – the most recent year for which data are available – suggests some potential contenders. And diabetes drug makers, which have already faced pricing squeezes, look to be right in the firing line.

The 25 most expensive drugs covered by Medicare Part D in 2017
Product Company Disease area Gross cost ($bn) No. of patients treated 
Revlimid Celgene Oncology 3.3 37,000
Eliquis Bristol-Myers Squibb/Pfizer Bleeding 3.1 1.1m
Januvia Merck & Co Diabetes 2.8 892,000
Lantus Solostar Sanofi Diabetes 2.6 1.1m
Xarelto Johnson & Johnson/Bayer Bleeding 2.6 952,000
Harvoni Gilead Liver disease 2.6 32,000
Lyrica Pfizer CNS 2.5 875,000
Advair Diskus Glaxosmithkline Respiratory 2.4 1.1m
Humira Pen Abbvie Autoimmune disease 2.0 52,000
Spiriva Boehringer Ingelheim Respiratory 1.7 717,000
Lantus Sanofi Diabetes 1.6 614,000
Novolog Flexpen Novo Nordisk Diabetes 1.5 546,000
Symbicort Astrazeneca Respiratory 1.5 995,000
Copaxone Teva CNS 1.5 26,000
Sensipar Amgen Kidney disease 1.4 154,000
Levemir Flextouch Novo Nordisk Diabetes 1.4 508,000
Ibrance Pfizer Oncology 1.4 20,000
Imbruvica Abbvie/Johnson & Johnson Oncology 1.4 19,000
Renvela Sanofi Kidney disease 1.3 184,000
Enbrel Sureclick Amgen Autoimmune disease 1.2 32,000
Humalog Kwikpen U-100 Lilly Diabetes 1.1 414,000
Restasis Allergan Ophthalmology 1.0 565,000
Victoza 3-Pak Novo Nordisk Diabetes 1.0 21,000
Tecfidera Biogen CNS 1.0 17,000
Latuda Sumitomo Dainippon Pharma CNS 1.0 112,000
      Total: $45bn  
Source: EvaluatePharma.

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