Track the prices of investigational drugs for COVID-19
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has dominated all aspects of American and international life over the past months. As the scope of the disease becomes more apparent by the day, we have begun to monitor the impact that COVID-19 has had on prescription drug prices, and unsurprisingly, there’s been volatility.
To facilitate broader investigation into the impact COVID-19, beyond what 46brooklyn is able to manage alone, we wanted to share within the public domain the list of national drug codes (NDCs) that include active ingredients that are currently being investigated in conjunction with COVID-19 according to ClinicalTrials.gov. This new tool will give users the ability to better track prices of drugs that are being evaluated as potential treatments options. Here’s how we did it, and how you can use it.
To generate this NDC list, we navigated to the web page for Clinical Trials and entered “COVID-19” into the condition or disease search bar.
Figure 1
Source: ClinicalTrials.gov
On 4/14/2020, we identified a whopping 524 studies related to COVID (in case you were curious, this was 410 just five days ago when we started this work). From here, we identified all trials whose intervention include drugs - 239 out of the 524 trials the database of Clinical Trials were flagged as “Drug” (up from 194 five days ago). We then extracted the names for all listed drugs in trials for COVID-19 and converted them to generic names when necessary. We then queried Elsevier’s Gold Standard Drug Database (GSDD) for all drugs whose generic names were equivalent to these identified generic products and whose dosage form was not topical. We limited the dosage form to avoid products unlikely to be used in relation to COVID-19 and to ensure we focused on dosages forms that were oral, inhaled, or injected.
To give an example of how this all worked, consider the study titled, “Application of Desferal to Treat COVID-19”.
Figure 2
Source: ClinicalTrials.gov
From this trial, we extracted the drug generic Desferal (deferoxamine mesylate) and found all NDCs associated with products whose ingredients included deferoxamine mesylate in GSDD. As shown below, this ingredient is in a total of three products, comprised of 11 different NDCs.
Figure 3
Source: Elsevier Gold Standard Database (GSDD), 46brooklyn Research
Put it altogether, and there are quite a few drugs being studied right now. As of now (4/14/2020), the list includes 120 different active ingredients, which are included in 927 different products (3,717 NDCs) marketed in the U.S. Here’s the full list. Going forward we’ll update this list weekly and post it on our ADPIT dashboard site.
NOTE: Not all drugs that show up on ClinicalTrials.gov will be in our database, as our database only includes drugs approved and currently marketed in the United States. So we’ll be missing drugs like favipiravir, which is being studied in Italy and Massachusetts, but is not yet approved in the U.S. (and therefore lacks an assigned NDC).
If we could offer a couple of observations to potential researchers who use this data… First, we were agnostic in pulling drugs into this list outside of the identified dosage form constraint. You will notice drug items like over-the-counter vitamin C and zinc, plus products whose trials are not yet active, etc. Depending upon the research being conducted, it may be appropriate to screen these products and refine the list for your needs. Second, we only focused on trials whose interventions were explicitly flagged by ClinicalTrials.gov as “Drug” trials. Finally, several of the drug trials included classes of medications as opposed to individual agents (i.e. ACE Inhibitors). Products associated with these drug classes are not included based upon the way that the name matching was generated between the ClinicalTrails.gov database and our drug reference database.
New COVID-19 Trial Flag in ADPIT Dashboard
Our first use case for this NDC list was to join it into the database underlying our recently-released Abnormal Drug Price Increase Tracker (ADPIT). We released this dashboard a few weeks ago in preparation for the spate of price changes that we think could be coming as the drug supply chain adjusts to rapidly changing supply and demand patterns driven either directly or indirectly by COVID-19. The dashboard simply identifies all drugs that, in any given week, experienced an “abnormal” price increase – where we define “abnormal” as a price that exceeds the 90th percentile price of the same drug over the trailing 52-weeks.
Now, just a couple weeks after launching this tool, it’s time for some enhancements. Figure 4 shows the new and improved ADPIT tool. First off, if you are not familiar with the original tool, please take some time to flip through our initiation report, which steps through how it works and provides a handful of use cases.
Once you become familiar with the tool, you may notice three enhancements in the new and improved ADPIT, shown below:
Figure 4
Source: Data.Medicaid.gov, 46brooklyn Research
First, you’ll now find a “COVID Trial Flag” filter at the top of the dashboard. Simply click the drop-down and the table will filter based on the latest COVID trial NDC list.
Second, we added the COVID Trial Flag as a color scale to the Relative Impact Score (RIS) chart on the bottom right of the dashboard. As a reminder, RIS measures the total weighted impact of all abnormal price increases each week, based on Medicaid’s drug utilization. If there are two drugs with the exact same abnormal price increase, the one with higher utilization will get scored higher. Add up the RIS for all of the drugs each week, and we get the total RIS displayed in the chart. Adding the color scale shows us how drugs with active ingredients currently undergoing some sort of a COVID-related trial have contributed to RIS in the past.
Honestly, we were shocked by this chart. Of the more than 831 drugs that have experienced at least one abnormal price increase so far in 2020, only 6% were COVID trial drugs. But this small slice of drugs was responsible for 33% of the RIS, as shown by the thick orange slice (no pun intended given that Vitamin C is being trialed) in the chart.
What the heck does all that mean? This is probably the most confusing paragraph we have ever written, and we’ve written some doozies in our time. Basically it just means that (in the aggregate), the basket of drugs that are now being tested as a possible treatment for COVID-19 were causing disproportionate pricing problems BEFORE they started being tested for COVID-19! The inflationary engine was already starting to rumble on this basket, which is not an ideal starting position should we see a spike in demand for them.
On that moderately unsettling note, let’s move on to the third and final enhancement to the ADPIT – the addition of a Drug Type filter. This allows you to filter between Brand and Generic drugs, which we had to add given that some drugs being trialed for COVID-19 are brand only. An added benefit of this new feature is that it’s a really handy way to quickly see all brand drug list price increases greater than 5% each week. Simply select “Brand,” pick the week, and voilá, weekly brand drug price increases.
Figure 5
Source: Data.Medicaid.gov, 46brooklyn Research
Thanks to John Wilkerson at Inside Health Policy for introducing the idea for us to start tracking the prices of trial drugs. We sincerely hope that advancing knowledge of the products associated with COVID-19 may aide those on the front lines or in the background in finding the answers needed to meet the current challenges presented by the pandemic.
We’d like to thank Johanna Butler and Jennifer Reck at the National Academy for State Health Policy (NASHP) for highlighting our new Abnormal Drug Price Increase Tracker in their recent COVID-19 drug pricing update.