Price and Adoption of Exhalation Delivery System With Fluticasone, 2018-2023

FDA approved an exhalation delivery system with fluticasone (EDS-FLU) for treatment of chronic rhinosinusitis with (2017) and without (2024) nasal polyposis. Concerns have emerged that high prices may limit access, but little is known about the extent of adoption. We analyzed publicly available Securities and Exchange Commission filings and Medicare Part D spending data to characterize EDS-FLU utilization, spending, and prices between 2018 and 2023. During this period, annual EDS-FLU utilization and spending increased 10.3-fold (32,869 to 339,400 prescriptions) and 12-fold ($21.1 million to $252.9 million), respectively. Despite reductions in the manufacturer net price ($272.98 to $228.34 per prescription after rebates/discounts; relative difference -16.4%), the Medicare Part D point-of-sale price increased ($642.72 to $745.11; relative difference 15.9%). In 2023, pharmacy markup ($516.77) over acquisition costs accounted for 69.4% of the point-of-sale net price. Policy reforms limiting price inflation by pharmaceutical supply chain intermediaries are necessary to promote access and lower drug spending.