Generic Chemotherapy Less Cost-Effective Than Expected


A recent study found that the generic version of capecitabine has yielded less cost savings over a 3-year span than expected, which is likely a reflection of the lack of generic manufacturers entering the market.

Furthermore, list of prices of branded as well as generic capecitabine continued to rise during the 14-year period of the study.

Capecitabine became the first oral chemotherapy available in generic form in 2014 after its patent had expired. Drug patent expirations should theoretically drive generic competition, thus lowering prices for cancer treatment. However, a case study for capecitabine has shown that generic competition and resulting drug prices have not panned out as expected.

Ashley L Cole, MPH, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, and colleagues conducted a case study of capecitabine to understand how generic entry into the market may affect orally administered anticancer drug prices. Researchers utilized the Truven Health MarketScan Commercial database to assess fluctuations in the list price of capecitabine and patient out-of-pocket expenses from 2002 through 2016. A total of 156,508 outpatient pharmacy claims were analyzed for branded or generic capecitabine. Data was adjusted to 2016 US dollars to account for inflation.

The research report was published in JAMA Internal Medicine (November 2017;177[11]:1679-1680).

From 2002 through 2013, per-fill list prices for branded capecitabine increased from $1367 to $2858.


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From October 2014 to December 2015, four generic versions of capecitabine entered the market. In 2014, the mean list price for a 1-month supply of generic capecitabine was $2598, which was 17% lower than the projected branded drug price. By 2016, the mean list price for the generic version was $2328, which was 36% lower than the projected branded drug price. Researchers noted that despite this decreases in mean list price, the 36% observed decrease was far lower than the expected 61% decrease.

Researchers believe that a lack of competition in the marketplace has had the largest impact on generic drug pricing. “We would expect that these drugs will continue to follow the natural erosion associated with supply and demand,” said one of the researchers in a statement (November 10, 2017). “If there is more competition and ample supply, pricing will continue to fall. If not, sometimes the price increases.”—Zachary Bessette