Oncology insights: New therapies and drug shortages
Recording now available
Oncology drug spending is seeing rapid growth that’s expected to keep exploding across the U.S. over the next several years. FDA granted 54 drug approvals for hematologic and oncologic malignancies between Jan. 2022 and May 2023. Yet, we’re experiencing several oncology drug shortages.
Interested in gaining additional insights? Learn about advancements in oncology therapy including CAR-T and new drug approvals. We also discussed challenges related to current drug shortages of generic injectable cancer drugs.
- Erin Fox, PharmD, BCPS
Associate Chief Pharmacy Officer, University of Utah Health
- Oncology drug spending in the United States is anticipated to reach $125 billion by 2027 as reported in the Use of Medicines in the U.S. 2023 report published by IQVIA.1
- There is a severe national shortage of multiple oncology drugs critical for treatment regimens across multiple disease states. The most severe shortages are occurring with capecitabine, carboplatin, cisplatin, docetaxel, fludarabine, fluorouracil and methotrexate.
- The Impact of Change report by Sg2 Analytics projects a greater than 14% growth in the outpatient cancer service line due in part to combination therapies.2 Near-term growth in chemotherapy administrations is expected to increase 13% between 2023-2028.
Estimated oncology drug inflation rate for Jan. 1 – Dec. 31, 2024
Top medication trends
The top five antineoplastic agents for Vizient pharmacy program participants have remained the same the past few years as far as amount of spend. However, rituximab has steadily decreased in total spend since the introduction of rituximab biosimilars to the market in December 2018. At the time of biosimilar entrance, brand rituximab ranked second in total provider spend; today, this product is ranked fifth.
Substantial change in overall spending can be found when comparing the top medications by spend in the latest editions of the Pharmacy Market Outlook (April 2021-March 2022 spend analyzed in the Winter 2023 edition versus April 2022-March 2023 spend analyzed in the Summer 2023 edition). The increased spend between these two periods can be attributed to the new FDA-approved indications that increase the number of patients eligible to receive these therapies. In the Summer 2023 Outlook, we provide the intravenous (IV) medications of greatest change as well as the oral medications of greatest change.
Between January 2022 and May 2023, the FDA granted 54 drug approvals for hematologic and oncologic malignancies. Of these new approvals, 20 were for new molecular entities – 13 intravenous and seven oral drugs – nine of which were approved via the accelerated approval pathway. Additional indications granted for previously approved medications made up 30 indications, and four approvals were pertaining to label changes or formulation additions specifically.
CAR-T utilization and spend increasing
The chimeric antigen receptor therapy (CAR-T) therapeutic class includes six agents and is one of the most expensive classes of medications purchased directly from the manufacturer by a healthcare system. Because these agents are purchased directly from the manufacturer, they are not included in the top spend and inflation rate information in the Pharmacy Market Outlook. However, their significant spend is important for consideration when creating and revising pharmacy budgets. The pricing for these one-time infusions have increased and now start at $424,000 per infusion.
Of the six CAR-T agents available, many compete with identical indications. To provide utilization insight for CAR-T agents with significant indication overlap, the Vizient Clinical Database/Resource Manager™ (CDB/RM) was queried to determine current trends in use, including individual disease states of acute lymphocytic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell and non-Hodgkin lymphoma (NHL).
From fourth quarter 2018 to first quarter 2023, four CAR-T agents were trended across the stated indications. The medications included Kymriah, Tecartus, Yescarta and Breyanzi. Collectively, the drug with the largest total administrations by volume is Kymriah (88%), followed by Breyanzi (6%), Yescarta (3%) and Tecartus (3%).
- IQVIA. The Use of Medicines in the US 2023: Usage and Spending Trends and Outlook to 2027. IQVIA Institute for Human Data Science. April 2023. Accessed June 19, 2023
- Impact of Change® Sg2 Report 2023