Pricing Trends and Overlapping Indications of Checkpoint Inhibitors for Cancer Treatment

Multiple checkpoint inhibitors are approved for cancer treatment in the United States, accounting for nearly 20% of Medicare Part B spending. To explore why prices remain high, this study analyzed pricing trends for checkpoint inhibitors from 2015 to 2024 and the degree of overlap of their US Food and Drug Administration (FDA)-approved indications.

For 11 FDA-approved checkpoint inhibitors, we studied quarterly average sales prices from public Medicare spending files from Q3 2015 to Q1 2024; prices were standardized to cost per 28-day treatment for non-small cell lung cancer. We compared the FDA-labeled indications as of January 2024 to determine the degree of overlap, defining indications on the basis of tumor type (or mutation status) and stage of treatment.

Monthly prices for checkpoint inhibitors decreased slightly over the study period, largely attributable to high inflation from 2020 to 2023. Five drugs, including pembrolizumab and nivolumab, maintained prices within 7% of each other; five other drugs were introduced at prices 3%-20% lower than the existing checkpoint inhibitors. In Q1 2024, monthly prices ranged from $7,783 in US dollars (USD) (ipilimumab) to $14,872 USD (dostarlimab). We identified 55 distinct indications for the 11 drugs; of these, 24 (44%) were approved for only one drug and 16 (29%) for only two drugs. Pembrolizumab accounted for 45 of 55 (82%) total indications and 18 of 24 (75%) nonoverlapping indications. Of eight checkpoint inhibitors launched since 2015, three were initially approved for nonoverlapping uses.

Prices of checkpoint inhibitors have decreased only slightly since introduction. This may be partially explained by lack of overlapping indications, which hinders direct competition among within-class drugs. Expanding drug price negotiations or incentivizing comparative effectiveness research may help to promote competition and address high prices.