Financial Impact of Treatment Choice in Chronic Myeloid Leukemia: A Comparison of Later Generation TKIs versus Imatinib from Patient and Payer Perspectives

Purpose: To evaluate the financial impact of treating CML with later-generation TKIs relative to imatinib on US patients and payers. Methods: The financial impact of later-generation TKIs (asciminib, bosutinib, dasatinib, nilotinib, and ponatinib) and imatinib was measured from patients' and payers' perspectives before (2024) and after the implementation of Inflation Reduction Act (2025), respectively. Changes in patient's annual out-of-pocket (OOP) costs of CML therapies by payer type (Medicare, Medicaid, and commercial) were used to indicate the financial impact on patients. Per patient per year (PPPY) treatment costs were measured as the weighted average cost across indicated adult CML populations derived using FDA label-based dosing and wholesale acquisition costs. Annual OOP limits by payer types were determined through literature review. The financial impact from payers' perspective was estimated as difference in monthly premium based on per member per month (PMPM) budget impact. Results: In 2025, the estimated PPPY cost for imatinib ($22,430 across generic and branded products, weighted by market share) and for later-generation TKIs (all >$100,000 except for dasatinib and nilotinib, which were $72,693 and $89,138, respectively) exceeded annual OOP limits under Medicare Part D, the average commercial plan, and the commercial plan with highest possible annual OOP limit, resulting in no change in patient financial impact when switching from imatinib to a later-generation TKI. An all-payer blended US health plan with 1 million members could expect to have 200 patients with Philadelphia chromosome-positive CML eligible for TKI therapy. Switching from imatinib to a later-generation TKI would increase the PMPM budget impact between $0.76 and $4.23. Conclusion: Both imatinib and later-generation TKI costs were projected to exceed annual OOP caps in 2025, likely resulting in minimal change in insured CML patients' OOP costs. The impact on insurance premiums from the adoption of TKI is likely to be relatively modest.