Understanding Alpelisib's Brand Names: Piqray vs. Vijoice
Alpelisib is the active ingredient in two separate branded medications, Piqray and Vijoice, both manufactured by Novartis. The cost of alpelisib varies significantly depending on which brand is prescribed, as they treat different conditions.
Piqray (for Breast Cancer)
- Indication: Piqray is used in combination with fulvestrant to treat a specific type of hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, advanced or metastatic breast cancer with a PIK3CA mutation.
- List Price: When Piqray launched in 2019, it had a list price of $15,500 for a 28-day supply. More recent figures from 2022 show the cost for a 28-day course around $19,555.
- Coupon and Pharmacy Prices: Pharmacy coupon prices may offer some relief, with sources indicating a 30-tablet pack (at 250 mg/day) can be found for around $12,208 at some US pharmacies. A 30-tablet supply of 300 mg/day also has a quoted price of approximately $12,336.
Vijoice (for PROS)
- Indication: Vijoice is approved for adults and children two years or older with PIK3CA-related overgrowth spectrum (PROS), a rare genetic condition causing tissue overgrowth.
- Wholesale Cost: Vijoice had a reported wholesale cost of $32,500 for a 28-day course in April 2022, nearly double the price of Piqray. This cost reflects its status as a treatment for a rare condition where few other options exist.
- Retail Price: Coupon prices through services like GoodRx show a discounted price of around $32,377 from an average retail price of over $35,000 for a common version.
Key Factors Influencing Your Out-of-Pocket Cost
The final amount a patient pays for alpelisib is rarely the full list price. Several key factors can dramatically affect out-of-pocket expenses.
- Insurance Coverage: Insurance plans vary widely in how they cover specialty medications like alpelisib. Your copayment, coinsurance, and deductible can all influence your final cost. Some plans may require prior authorization or have high coinsurance rates, which can result in thousands of dollars in monthly expenses.
- Dosage and Duration: The prescribed dosage and the length of your treatment also impact the total cost. Some protocols, for instance, might require a higher starting dose or a more frequent dosing schedule, increasing the amount of medication needed.
- Pharmacy: The specific pharmacy you use, whether it's a retail pharmacy or a specialty pharmacy for cancer drugs, can lead to variations in price. Using pharmacy coupon programs can also impact the final price.
- Financial Assistance: The most significant factor in managing the high cost is accessing financial assistance programs offered by the manufacturer and non-profit organizations. These programs can reduce or eliminate patient out-of-pocket expenses.
- Generic Availability: Alpelisib is currently only available under its brand names, Piqray and Vijoice. The lack of a generic alternative prevents the lower costs associated with generic competition.
How to Manage the High Cost of Alpelisib
Navigating the high cost of specialty drugs can be daunting, but several strategies and programs exist to help patients afford their treatment. Patients should work closely with their healthcare team to explore all available options.
- Manufacturer Patient Support Programs: The manufacturer, Novartis, offers dedicated programs for patients, including co-pay assistance for those with private insurance and assistance foundations for eligible uninsured or underinsured individuals.
- Non-Profit Foundation Assistance: Independent charitable foundations provide aid for specific medical conditions. Patients with metastatic breast cancer or PROS may qualify for assistance from organizations like the Patient Access Network (PAN) Foundation, the HealthWell Foundation, or the Patient Advocate Foundation.
- Discount Cards and Coupons: Pharmacy discount cards from services like Blink Health or GoodRx can provide some level of savings, especially for cash-paying customers. However, these are often less comprehensive than manufacturer or foundation programs for covering the cost of specialty drugs.
- Insurance Advocacy: A social worker or patient advocate at your treatment center can help you navigate insurance complexities, denials, and appeals to ensure you receive the maximum possible coverage for your medication.
Comparison of Piqray and Vijoice Costs and Features
| Feature | Piqray (Breast Cancer) | Vijoice (PROS) |
|---|---|---|
| Indication | HR-positive, HER2-negative, PIK3CA-mutated metastatic breast cancer | PIK3CA-related overgrowth spectrum (PROS) |
| Reported Wholesale Cost (28-day) | ~$19,555 (based on 2022 data) | ~$32,500 (based on 2022 data) |
| Typical Patient Cost | Varies significantly based on insurance coverage, dosage, and assistance programs. | Varies significantly based on insurance coverage, dosage, and assistance programs. |
| Manufacturer Co-pay Support | Yes, Novartis Oncology Universal Co-pay Program for privately insured patients. | Yes, Novartis Oncology Universal Co-pay Program for privately insured patients. |
| Patient Assistance for Uninsured | Yes, Novartis Patient Assistance Foundation (NPAF) for eligible low-income patients. | Yes, Novartis Patient Assistance Foundation (NPAF) for eligible low-income patients. |
Conclusion
The list price for alpelisib, whether under the brand name Piqray for breast cancer or Vijoice for PROS, is exceptionally high in the United States. This reflects its status as a specialty, targeted therapy with no generic alternatives. For patients, however, the sticker price is not the full picture. The final out-of-pocket cost is heavily influenced by insurance coverage, dosage, and, most importantly, financial assistance programs. Manufacturer programs from Novartis and independent non-profit foundations can dramatically reduce or eliminate patient costs for eligible individuals. It is crucial for patients and their care teams to thoroughly investigate these resources to make this life-changing medication accessible and affordable.
For more information on Novartis's patient assistance options, visit the official patient support pages or contact your healthcare provider's financial counseling office.
Outbound Link: Novartis Patient Assistance Foundation
