Although multiple myeloma is a relatively rare cancer, numerous therapies to treat it are available. Because of these products’ efficacy, they have made the disease manageable — and, as a result, costly.

“The mainstays of treatment for multiple myeloma are considered specialty medications and therefore placed into a specialty tier,” says Raechele McMahan, vice president and general manager, enterprise specialty pharmacy at Prime Therapeutics. “The therapies are also subject to utilization management, which primarily consists of prior approval.”

Multiple factors come into consideration when choosing a treatment regimen, such as a patient’s treatment goals and the person’s age and insurance coverage. Whether a patient is a stem cell transplant candidate should also be taken into account.

“Combination therapy is the standard of care for treating multiple myeloma,” says McMahan. “Due to the use of triple combination therapy in multiple myeloma, the average annual cost of treatment or multiple myeloma can range from $100,000 to more than $250,000.”

Multiple myeloma has some common comorbidities that may complicate a person’s treatment. “Patients are typically at high risk for exhibiting C.R.A.B. symptoms: C = hypercalcemia; R = renal failure; A = anemia; B = bone lesions,” McMahan says. “Each of these symptoms, if present, can cause either treatment modifications and/or additional therapies to be included to ease patient symptoms….Many of these patients also have an increased risk of infection, which may require antibiotics for treatment and/or immunoglobulin therapy for prevention.”

There are more therapies in the pharma pipeline, although “the FDA is not currently reviewing any multiple myeloma agents,” according to McMahan. She adds that there has been excitement for CAR-T therapy use.