Eltrombopag, known by brand names Promacta in the United States and Canada, and Revolade in the European Union, is a medication used to increase platelet counts. It is prescribed for individuals with chronically low platelet counts due to conditions like chronic immune thrombocytopenia (ITP) or severe aplastic anemia (SAA). The financial burden associated with this medication is a notable concern for both patients and healthcare systems.
Current Cost Overview
The cost of eltrombopag without insurance can vary significantly depending on the dosage and pharmacy. A 25 mg tablet of Promacta may be listed for approximately $47.96 to $71.68 per pill. The 50 mg tablet can average around $315 per pill in the U.S..
These per-pill costs translate into substantial monthly and annual expenses. For example, a 25 mg daily dose could cost approximately $22,812.50 annually, while a maximum daily dose of 100 mg could lead to an annual cost of up to $92,250.00. These figures represent list prices, and actual out-of-pocket costs can differ based on various factors.
Factors Behind the Price
The substantial price of eltrombopag is influenced by several factors inherent to the pharmaceutical industry. Extensive research and development (R&D) efforts are required to bring a new drug to market, involving significant financial investment and a high rate of attrition for potential products. These R&D costs must be recouped from the limited number of patients who will use the drug.
Eltrombopag is categorized as an “orphan drug,” a designation for medications treating rare diseases affecting a small patient population, typically fewer than 200,000 people in the US. This status grants pharmaceutical companies incentives, including market exclusivity, which can last for seven years in the US and up to ten years in Europe. This exclusivity limits competition and allows manufacturers to set higher prices to recover their investment from a smaller market.
Patent protection further contributes to the high cost, providing a period during which the developer has exclusive rights to sell the drug, typically up to 20 years, though extensions are possible. This allows companies to generate profit before cheaper generic alternatives can enter the market.
Navigating Affordability
Managing the high cost of eltrombopag often involves exploring various financial assistance options. Health insurance coverage, whether private plans, Medicare, or Medicaid, plays a significant role in reducing out-of-pocket expenses. Patients should understand their specific plan’s deductibles, copayments, and co-insurance, as these determine the portion of the cost they are responsible for.
Patient assistance programs (PAPs) are offered by pharmaceutical companies, such as Novartis for Promacta/Revolade, and non-profit organizations. These programs provide financial aid or even free medication to eligible individuals, often based on income and insurance status. Eligibility requirements vary, but typically involve demonstrating financial need and having a confirmed diagnosis for which the drug is prescribed.
Copay cards and coupons can also help commercially insured patients lower their out-of-pocket costs. For example, the Promacta Novartis Oncology Universal Co-Pay Card allows eligible commercially insured patients to pay as little as $25 per prescription, with a maximum savings of $15,000 per calendar year. Non-profit foundations like the HealthWell Foundation and the Patient Advocate Foundation also offer copay assistance programs for eltrombopag, helping to cover co-pays, co-insurance, and deductibles.
General prescription discount programs and cards, available through various pharmacies or online platforms, can also offer savings for both insured and uninsured individuals, though these are drug discount programs and not insurance plans.
Future Cost Trends
The future cost of eltrombopag is likely to be influenced by patent expiration and the introduction of generic alternatives. Several patents protecting Promacta are expected to expire around August 1, 2027, for indications such as chronic immune thrombocytopenia and chronic hepatitis C virus infection. Another patent is listed with an expiration date in 2028.
A generic version of eltrombopag olamine was approved by the FDA in April 2024. The commercial availability of this generic product, however, may still be pending due to existing drug patents and exclusivity. Once generic versions become widely available, increased competition is expected to drive down the overall cost of eltrombopag, making it more accessible for patients.