Sen. Jacky Rosen (D-Nev.) wants the Department of Health and Human Services (HHS) to investigate why a low-cost generic cancer drug is not widely available to patients.
In a letter sent to HHS on Tuesday and shared first with The Hill, Rosen questioned why Medicare patients pay $3,000 a month for abiraterone, a generic oral medication used as part of prostate cancer treatment, when a version which costs 171 dollars is also on the market.
The drug is sold by CivicaScript, a nonprofit organization that works with manufacturers to develop a drug and then partners with insurers, pharmacies, and pharmacy benefit managers (PBMs) to sell it to patients for a fraction of the price it would cost other way.
The cost of Civica’s drug is $160, with a suggested final consumer price of $171. But the drug is only available to a limited number of patients, according to Rosen and Civica.
Rosen called on HHS to investigate and identify “market barriers” that prevent widespread access to abiraterone, as well as other low-cost medications that are blocked from patient access.
Abiraterone is considered a “specialty medicine,” meaning only specialized pharmacies can dispense it. Many PBMs run their own specialty pharmacies and make money by distributing expensive medications, so there is a financial incentive for them not to participate in Civica.
Only one of the three largest PBM-owned specialty pharmacies purchased or distributed Civica’s version of abiraterone, and only in small quantities, according to Civica.
“A cancer diagnosis is difficult enough for patients to navigate with the best care, but it is unacceptable for an approved low-cost treatment to be limited to the point where patients cannot easily access the treatment or benefit from cost savings, ” Rosen wrote.
“Patients should now be seeing a dramatic reduction in the cost of abiraterone due to Civica’s lower pricing structure, and it is unacceptable that the cost for cancer patients to access this life-saving prescription medicine has remained unreasonably high due to the barriers that prevent Civica’s medicine from being sold. widely available,” Rosen added.
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