The NHS has switched from branded Gleevec to generic imatinib. This was started when the patent expired for CML in 2016 and has continued for a rare GI tumour called GIST in 2021. Of course to cover the loss in revenue, Novartis developed follow-on medicines (nilotinib). One could argue that the high costs in the US of the innovator medicine was what paid for the research into the original and all the other failed drugs. That said, when it lost patent, it was selling $4bn a year at $110k per patient in the US – so it’s easy to argue that they’d had their fill.
This makes for an interesting read on pricing and generic imatinib in the US https://ascopubs.org/doi/full/10.1200/JOP.2016.019737
For the impact on cost of generics, BNF lists gleevec as £973 for 60 tablets and generics are priced from £100 up to £900 depending on maker. The active ingredient of every generic is chemically identical, with the same human exposure when taken. The dose is 400mg a day (four tablets) so that’s £200 to £2000 per month. It’s on the WHO essential medicines list for a reason.
Nilotinib is dosed at 600mg per day and costs £2,432.85 per month. Ive not looked at comparative efficacy or safety, but you can bet that NHS purchasers will have!
As an aside, Novartis are currently laying off 8000 workers, possibly as a result of not developing a drug that has filled that revenue hole left by what is a fantastic drug. Second album syndrome is not just for bands.