Rising costs of rhinologic medications outpace inflation from 2014 to 2020
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Key takeaways:
- Ten of the 14 analyzed drugs had an average price increase of 42.06% ± 22.27%.
- Four of the drugs had an average decrease of 10.78% ± 7.36%.
- Only 2019 saw an overall decrease in average nominal price changes.
The overall average annual percentage changes in costs for 14 popular rhinology medications outpaced the general annual inflation rate for 5 of 7 years evaluated, according to a study published in Annals of Allergy, Asthma & Immunology.
These cost increases may pose barriers to drug adherence among vulnerable populations, Sina J. Torabi, MD, second-year otolaryngology resident, University of California, Irvine, and colleagues wrote.
“As a resident, I noticed that many of the common medications we were recommending or prescribing to our allergic rhinitis and chronic rhinosinusitis patients were going unused and unfilled on subsequent visits. Many patients were stating that they were unable to afford the medication, or unable to afford using it every day,” Torabi told Healio.
Torabi said that he was shocked because he had thought that many of these medications were ubiquitous and could be found on shelves and in the cabinets of most homes around the country.
“At a time when the drug affordability spotlight has been on medications like insulin, our team wanted to evaluate the affordability of medications that we commonly recommend,” Torabi said.
Torabi discussed his idea with Edward Kuan, MD, MBA, associate professor of otolaryngology at University of California, Irvine, who noted a similar trend in his practice.
Study methods, findings
The researchers accessed the Medicaid Affordable Care Act and extracted National Average Drug Acquisition Cost (NADAC) data representing wholesale acquisition costs for community pharmacies from January 2014 through December 2020.
Specifically, the researchers examined data for intranasal corticosteroids, oral antihistamines, antileukotrienes, intranasal antihistamines and intranasal anticholinergics. They also calculated inflation based on the U.S. Bureau of Labor Statistics Consumer Price Index inflation calculator.
Inflation-adjusted prices for 10 of the 14 medications that the researchers examined increased faster than the 1.95% average annual inflation rate between 2014 and 2020. These increases included:
- beclomethasone dipropionate (Qnasl, Teva Pharmaceuticals), 77.53%;
- ciclesonide (Omnaris, Covis Pharma), 73.84%;
- beclomethasone (Beconase AQ, Omega Pharma), 56.68%;
- ipratropium bromide (Atrovent, Boehringer Ingelheim), 56.57%;
- mometasone furoate monohydrate (Nasonex, Perrigo), 38.22%;
- azelastine/fluticasone propionate (Dymista, Meda Pharmaceuticals), 27.34%;
- olopatadine hydrochloride (Patanase, Alcon Inc.), 27.32%;
- azelastine (Astepro, Bayer), 21.87%; and
- montelukast sodium (Singulair, Merck), 14.48%.
- Fluticasone propionate (Xhance, OptiNose): 11.67%
Inflation-adjusted costs decreased for four medications:
- budesonide (Rhinocort, Johnson & Johnson), –1.22%;
- fluticasone (Flonase, GSK Consumer Healthcare), –6.78%;
- flunisolide (Nasalide, Patheon Inc.), –14.56%; and
- loratadine (Claritin, Bayer), –20.55%.
Maximal shifts in drug price costs within a calendar year ranged from a 10.7% decrease for Claritin to a 50.3% increase for Patanase, which also experienced the greatest average annual percentage change in NADAC nominal price at 12.8%.
The only year that experienced an overall decrease in average annual nominal price change for all rhinologic medications was 2019.
Beconase AQ had the largest price fluctuation within a calendar year among the intranasal corticosteroids, with a 44.1% increase in nominal price and a peak price of $11.50/g in 2018.
Further, overall inflation-adjusted price changes included 36.44% ± 23.65% for the six medications that did not have generic equivalents and 17.97% ± 35.84% for the eight medications that did have generic equivalents, which the researchers did not consider a significant difference.
Implications of price changes
The researchers associated variations in medication prices with growing public health care expenditures and per capita health care costs. Also, the researchers noted that these rising costs immediately burden individuals who are sensitive to price fluctuations and affect the availability of affordable health insurance plans.
“The degree with which the prices of many of these medications have outpaced inflation was most surprising. A greater than 50% increase in real price over the course of 7 years after inflation can really be impactful for many people, especially at a time when wages themselves are struggling to keep up with inflation,” Torabi said.
“What’s more surprising is that this price increase didn’t necessarily vary based on whether the medication had a generic version. There is no real reason that we can think of regarding why a medication that has been around for more than 20 years and has generic versions should still be raising its price over and above the rate of inflation,” he continued.
The initial absolute costs of the four medications that experienced decreases in their inflation-adjusted prices were among the lowest in the study, the researchers continued, adding that small changes in their absolute costs could significantly affect their percentage changes over the years. The availability of generic versions of these medications could contribute to their overall lower costs as well, the researchers added.
Although the causes of high drug prices are multifactorial, the researchers said, familiarity with this data could affect clinician decisions and lead to mitigation of the patients’ cost burdens, making this topic important for clinicians to understand.
“Our findings are likely not unique to these medications alone. If this is happening for OTC steroid sprays and allergy pills, this is likely a trend for most drugs,” Torabi said.
The researchers additionally attributed high costs to the FDA’s patent approval process, as pharmaceutical companies claim their high prices recoup research and development costs, although the researchers noted there was insufficient evidence to support these claims. As patients skip doses or choose not to refill prescriptions due to their high costs, the researchers also said that patient nonadherence has substantial implications for population-level patient health. For example, the researchers said, cost-related underuse can have dire outcomes for patients with asthma.
Affordability promotes treatment adherence, impacting quality of life and even life expectancy, the researchers said, with high costs potentially exacerbating disparities in care among racial and ethnic minorities.
Physicians who frequently prescribe these medications would benefit from increased price transparency and awareness as they direct patients who are particularly vulnerable to cost fluctuations to more cost-effective options, the researchers said, as they help patients make more informed decisions about their medication choices and reduce cost burdens on individuals and the health care system alike.
“Acknowledging this and the direction that prices take, doctors should learn what these costs are to patients, so they may have frank discussions with patients, and prescribe alternatives and generics when able,” Torabi said.
Changes in policy may help patients as well, Torabi suggested, but they will not be easy.
“There are many potential options, most of which have been discussed politically in some capacity or another. However, there unfortunately isn’t an easy or quick fix in the current U.S. health care system,” Torabi said. “If we could encourage insurance companies to switch to flat fee copayments for medications, that would be a start.”
The natural next step in this research, Torabi said, would be to evaluate the costs of the generic versions of these drugs.
“How much money could be saved if more generics were purchased? How many people would benefit if the length of monopoly drug rights were decreased from the 20 years it currently is?” Torabi asked.
“We may consider expanding our work to other medication classes as well, and ultimately figuring out what costs are incurred at the consumer/patient level, as our work focuses on the surrogate measure of the cost incurred by pharmacies and drugstores,” he said.