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    The year's Top Drugs

    Significant therapeutic advances that can help combat or cure life-threatening diseases have been made in the last few years. However, achieving a delicate balance between accessibility and affordability in the era of costly treatments poses a challenge.

    A report unveiled by the IMS Institute for Healthcare Informatics highlights aspects of medication use and spending (Table1). According to the report, total spending on medications in the U.S. reached $310 billion in 2015, an 8.5% jump from the previous year.  Major factors fueling growth included new branded products, generic spending, and expired patents.

    New brands available for less than 2 years, notably specialty medicines, accounted for over half of the total spending growth.  New brand spending increased by $24 billion, primarily driven by new hepatitis C treatments, such as ledipasvir/sofosbuvir (Harvoni, Gilead).  Other specialty drugs steering growth include an easier dosing option for multiple sclerosis, a combination therapy for HIV, and treatments for autoimmune conditions and cancer. Traditional medicines, including SGLT2 inhibitors targeting diabetes and a new human papilloma virus vaccine, contributed 33% to new brand spending growth (see Drugs that are driving growth).

    Table 2  shows the top 20 prescribed medications in the U.S. according to IMS health.

    The IMS report also cites that generic spending increased by 7.4% —$7.9 billion—fueled by the availability of aripiprazole (Abilify, Otsuka), esomeprazole (Nexium, AstraZeneca), and celecoxib (Celebrex, Pfizer) generics.  Branded generics, non-original medicines marketed with trade names, grew sharply on an invoice price basis.

    IMS Health has not released a 2016 prescription drug spending report yet. In 2015, spending on oncology drugs increased 18% –to $39 billion: targeted therapies, such as monoclonal antibodies and protein kinase inhibitors, took the lead. These agents have shown efficacy against various tumor types by targeting gene mutations in cancer cells, while minimizing impact to surrounding healthy cells.  Monoclonal antibodies accounted for 35% of total spending, driven both by novel PD-1inhibitors and existing treatments.  PD-1 inhibitors target immune checkpoints and act as an “off switch” that helps to keep T-cells from attacking other cells. The agents have demonstrated efficacy against many tumor types, including melanoma and hepatocellular carcinoma.  Current game-changers, pembrolizumab (Keytruda, Merck) and nivolumab (Opdivo, Bristol-Myers Squibb), are undergoing more than 135 clinical trials for additional indications.  The 27% increased spending on protein kinase inhibitors was mainly due to the recent approvals of palbociclib (Ibrance, Pfizer) and ibrutinib (Imbruvica,  Janssen Biotech).

    Monica Shah, PharmD
    Monica Shah, PharmD is a Clinical Pharmacist at RWJ Barnabas Health in New Jersey and adjunct faculty member at Ernest Mario School of ...

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