By Henry Ehrlich
Dupixent—the brand name for dupilumab, the first biologic for moderate-to-severe atopic dermatitis—has been approved by the FDA, and as we predicted the price is a stunner. In fact, this breakthrough therapy for a truly miserable disease is even higher than we speculated last year–$37,000 list price, for what looks like forever. We have to ask, what do we mean by affordable health care when one drug is priced like this?
Don’t get me wrong! This is a drug that will restore quality of life for millions of patients. I’ve been following it avidly for several years since I watched Dr. Emma Guttman-Yassky speak to the New York Allergy and Asthma Society over roast chicken and salad. The “before” slides she put up on the screen looked like napalm victims. Dr. Peter Lio described the misery of these patients for us when he wrote about the drug last year: “The relentless itch, continual skin breakdown, poor sleep, cracked and painful skin that can become infected: All of these are part of daily life for those with more severe eczema. The quality of life indices for this disease show that day-to-day suffering exceeds that of many other chronic conditions considered much more dangerous.”
The plight of these patients often begins in early childhood, and is a precursor to asthma and food allergies. As I wrote a couple of years ago, “People will go to great lengths to achieve some relief, even at the expense of their own long-term health. While most people are wary of steroids and will avoid their use even when it’s really bad for them, which happens often with asthma, AD patients will use them too much.”
How much will it really cost? The New York Times, which had an explosion of drug-price reporting last year because of the Mylan fiasco, did some excellent reporting on the new biologic.
Among the highlights, “Regeneron Pharmaceuticals and Sanofi took the unusual step of directly negotiating with insurers over the price and other details ahead of time….They also often must demonstrate that other, cheaper drugs did not work before an insurer will cover more expensive drugs. Regeneron has said it also negotiated a more streamlined approval process, although patients will still have to try other drugs first. It also said it had a patient assistance program to help people who have troubling paying.”
The Times also cited Dr. Steve Miller, chief medical officer at Express Scripts, the big pharmacy benefits manager, to the effect that the drug makers held all the chips because the drug works well and has no real competition. Also if it’s any consolation, the Times says that Humira and Enbrel, also for skin diseases, run about $50,000 list.
So what will they pay and when will they pay it? I asked Dr. Paul Ehrlich who said, “Since it’s only approved for patients 18 and up, it’s not going to be an issue for me since most of my patients are children.” For them, it’s wet wraps, topical steroids, and if all else fails referral to Dr. Xiu-Min Li. He did note that trials for younger patients are on their way, probably for ages 12-17 to start.
Our contributor, Dr. Purvi Parikh, who occupies the adjacent office to Dr. Ehrlich at Asthma and Allergy Associates of Murray Hill, adds, “This is a great non-steroidal alternative we can offer our severe eczema patients. Often eczema takes a toll on quality of life as well as self-esteem. It is nice to have another agent especially for those who have been reliant on steroids for many years with no avail.”
Promising though this treatment is, it won’t take patients by storm. Because of the expense, the criteria will include exhausting all other methods and then throwing them on the mercy of their insurance companies. I asked my dermatologist if he had any likely patients. “We’ll have to see.”