Letter to the Editor The Price of Aptiom To the Editor: I was pleased to read your recent articles on epilepsy in the November edition of P&T. Thank you for educating your readers on this serious brain disorder. I do have a question, however, on the methodology for calculating the yearly costs of therapy outlined in the “Pipeline Plus” feature “Modest Growth Seen in Epilepsy Market” (pages 786–787). Looking at Aptiom, which has a recommended dose range of 800 mg to 1,200 mg/day once daily, the cost of a course of therapy per year is listed as $14,585 to $21,878. The footnote at the bottom of the page states costs are calculated based on wholesale acquisition cost (WAC) and regimen provided and rounded to the nearest dollar. Our immediate reaction was that the range was somewhat high based on our internal calculations; we therefore re-ran our calculations, and provide details below for your convenience. The current WAC cost of Aptiom 800 mg (listed in Red Book) is $19.98 per tablet. Taken once daily, the yearly cost would be calculated as $7,292.70 ($19.98 x 365 days’ supply). As there is no 1,200-mg tablet, the 1,200-mg dose would be achieved by taking two of the 600-mg tablets simultaneously, once daily. The WAC price for the 600-mg tablets is the same as for the 800-mg, i.e., $19.98 per tablet, so the yearly cost would be twice that of the 800-mg regimen, or $14,585.40. The yearly cost range would therefore be $7,292.70 to $14,585.40 for the 800-mg and 1,200-mg/day doses, respectively. This is significantly lower than what is listed in the article. I understand that prices are updated regularly, and at the time this article was written the prices may have been different than they are today. However, the differences in the article are off by thousands of dollars, and prices for these agents have not changed since the beginning of the year. The chart listing price comparisons allows readers to determine relative pricing across the therapeutic category, which may impact their for-

mulary placement and prescribing decisions. Having accurate information is essential for them to make these decisions. Thank you for your consideration of this matter. I look forward to your response. Ronnie DePue, PharmD, CGP, FASCP Director, Health Economics and Outcomes Research Sunovion Pharmaceuticals, Inc. Marlborough, Massachusetts Author’s Response The pricing provided in the P&T articles is calculated using a common dosage strength for the regimen listed. In this instance, the regimen listed is 800 to 1,200 mg/day, and the only common dosage strength between the two doses is 400 mg. For this reason, we calculated the price of two 400-mg tablets to arrive at the 800-mg/day price of $14,585 and calculated the price of three 400-mg tablets to arrive at the 1,200 mg/day price of $21,878. Although there may be a different regimen available for patients, it is hard to anticipate the physician prescribing patterns for each drug, in each scenario, for each patient. For consistency among all drugs, we calculate the regimen pricing with this consistent methodology. You are correct in your pricing of the regimen, provided the physician utilizes the specific tablet strengths you have mentioned. If the 800-mg tablet is used for the 800-mg/day regimen, the pricing would be $7,293, and if the 600-mg tablet is used for the 1,200-mg/day regimen, the pricing would be $14,585. Thank you for helping us to provide our readers with additional pricing options. Kunj Gohil, PharmD, RPh Central Services Manager Medical Services MediMedia Managed Markets Yardley, Pennsylvania

Vol. 40 No. 1  •  January 2015 • P&T 35 ®