Prices and Spending for Phosphodiesterase 4 Inhibitors in Pulmonary and Dermatologic Disease

In this analysis of US spending on two phosphodiesterase 4 inhibitors, roflumilast and apremilast, the authors found that apremilast was priced 10-times higher than roflumilast, and this gap widened after roflumilast faced generic competition starting in 2022. From 2014 to 2024, apremilast spending totaled $16 billion, which could have been reduced by 84% ($13.5 billion) had roflumilast been substituted. These findings raise concerns about incentives for companies to develop new higher-cost medications rather than repurposing existing ones for new indications.