You never know what a new hire will end up costing. Take the case of a new hire who started work June 1 of last year. She was on a $500,000 a year drug but the employer didn’t know it.
Some plan sponsors are itching to find solutions to high cost drugs but with little success. You can’t negotiate prices when a product is under patent. The only way to reduce Rx costs is to stop covering expensive ones and instead rely on over 32,000 low cost FDA approved generic drugs covering every therapeutic class.
The article below illustrates another high cost drug that won’t cure a disease and must be taken for a lifetime at a cost of almost $50,000 per year.
April 16, 2025
Use and Cost of First-Line Biologic Medications to Treat Plaque Psoriasis in the US
Benjamin N. Rome, MD, MPH1; Jihye Han, PharmD, MPH1; Helen Mooney, MPH1; et al
Benjamin N. Rome, MD, MPH1; Jihye Han, PharmD, MPH1; Helen Mooney, MPH1; et alAaron S. Kesselheim, MD, JD, MPH1
Question How has the use and cost of first-line biologic treatments for plaque psoriasis changed from 2007 to 2021?
Findings This cross-sectional study of 76 781 patients initiating a tumor necrosis factor-α inhibitor or an interleukin (IL)-12/23, IL-17, or IL-23 inhibitor found that the average annual net treatment cost increased from $21 236 in 2007 to $47 125 in 2021. Variations in drug costs increased over time, and the average cost in 2021 would have been 44% lower if patients used the lowest-cost drug in the same mechanistic class.
Meaning These findings suggest that there are substantial opportunities for savings by using lower-cost biologics for plaque psoriasis or ensuring that prices align with these drugs’ comparative effectiveness and safety.
Abstract
Importance Plaque psoriasis is increasingly managed using anti-inflammatory biologic medications, including tumor necrosis factor (TNF)−α and interleukin (IL) 12/23, IL-17, and IL-23 inhibitors. How these differently priced biologics are used has implications for the overall cost of care in the US.
Objective To measure trends in the use and cost of first-line biologic treatments for plaque psoriasis from 2007 to 2021.
Design, Setting, and Participants This was a cross-sectional study using a national commercial claims dataset (2007-2021) of biologic medication−naive patients with plaque psoriasis who initiated a biologic medication from 1 of 4 mechanistic classes, including 4 TNF-α inhibitors, 1 IL-12/IL-23 inhibitors, 3 IL-17 inhibitors, and 3 IL-23 inhibitors. Data analyses were performed from August 2023 to October 2024.
Exposures Patient demographic characteristics (sex, age, geographic location, insurance type) and clinical characteristics (comorbidities, previous nonbiologic treatments for plaque psoriasis).
Outcomes Trends in the proportion of patients initiating each biologic medication and the average estimated annual treatment costs over time, using commercial estimates of net prices accounting for average manufacturer rebates. Logistic regression was used to evaluate demographic and clinical characteristics associated with initiating TNF-α vs IL inhibitors. Estimated savings were calculated for patients who had initiated the lowest-cost treatment within each class.
Results Among 76 781 patients with plaque psoriasis who initiated biologic medications, 50.4% were female and 49.6% male, 71.8% were age 30 to 59 years, and 30% had concurrent inflammatory arthritis. From 2007 to 2021, the proportion of patients initiating IL rather than TNF-α inhibitors increased; in 2021, 42% initiated IL-23 inhibitors and 21% initiated IL-17 inhibitors. The average annual treatment cost increased from $21 236 in 2007 to $47 125 in 2021. In 2021, costs ranged from $12 413 (infliximab) to $70 043 (risankizumab). If patients initiated the lowest-cost medication in each class, the average annual treatment cost would have been 44% lower in 2021 ($26 363). Patients who were male, older, residing in the Northeast, and did not have comorbid arthritis or inflammatory bowel disease had higher odds of initiating IL inhibitors than TNF-α inhibitors.
Conclusions and Relevance This cross-sectional study found that from 2007 to 2021, treatment costs increased for biologic medications used to treat plaque psoriasis. Substantial savings are available if more patients and physicians use the lowest-cost options and/or if drug prices were better aligned with the comparative effectiveness and safety of each medication.
