Most patients with chronic myelogenous leukemia (CML) are being prescribed costly second-generation tyrosine kinase inhibitors (TKIs), even though generic imatinib has been available since 2016, found a recent study in JAMA Oncology.

The study included patients with a CML diagnosis who initiated treatment with a TKI between January 1, 2010, and December 31, 2019, and were identified using the database OptumLabs Data Warehouse. Medical and pharmacy claims data were extracted from the database for patients with commercial insurance and Medicare Advantage.

For their first year of TKI treatment, only 19% of patients started by filling a prescription for a second- or third-generation TKI in 2010, and by the end of the year this number was 34%. In contrast, in 2019, more than half of patients (56%) started their treatment by filling a prescription for a second- or third-generation TKI even with generic imatinib being available.

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“Despite the lack of evidence for an overall survival difference between first- or second-generation TKIs, most patients with CML are now prescribed a second-generation TKI in the US,” the study authors wrote. 

The cost of TKI treatment per day has also increased over the years, jumping from $243 in 2010 to $354 in 2018. Most of these costs have been absorbed by health plans, with $232 of the $243 daily cost paid by the health plan in 2010 and $346 of $354 daily cost paid by the health plan in 2018.

The study authors concluded that generic price competition alone may be “insufficient” to reduce the price of cancer drugs in the United States.


Lyman GH, Henk HJ. Association of generic imatinib availability and pricing with trends in tyrosine kinase inhibitor use in patients with chronic myelogenous leukemia. JAMA Oncol. Published online October 1, 2020. doi:10.1001/jamaoncol.2020.4660