Competition in the Biosimilar Marketplace

Bruce Feinberg, DO: It sounds as if the value is high for biosimilars. You all have a good long-term strategy and believe they are critical for that long-term strategy. Kathy, you’ve said that even a 5% difference could be meaningful. When we talked about what biosimilars have to do to gain market adoption and make an impact 2 or 3 years ago, there was this notion that it had to be 30%.

We talked earlier about limitations, and yet I’m hearing as little as 5% could be significant. All that sounds like it’s really strong.

Bhavesh Shah, RPh, BCOP: One of the things I forgot to mention is that, as you see multiple biosimilars coming onto the market, the wholesale acquisition cost with the list price of the reference product actually stops increasing. Then the ASP [average selling price] starts going down. That’s 1 of the things we don’t actually think about. We’re lowering the cost. If we didn’t have the biosimilars, the cost of the reference product would continue to go up and the ASP would also continue to go up.

Bruce Feinberg, DO: Let me challenge you with the counterpoint. As a result of what we’re saying today and the compelling case you’re making for biosimilars, a company that has significantly impacted biosimilars, Genentech Inc, decides they’re going to go to parity with the best of the current biosimilar contracts for each of their brands. Do you go back to the established brand that has all the evidence?

Bhavesh Shah, RPh, BCOP: Absolutely. It’s all about cost.

Bruce Feinberg, DO: Wait a minute. Say it again. Was that absolutely?

Bhavesh Shah, RPh, BCOP: Yes, if they’re going to lower their price to the level of the biosimilars or even lower, if it’s more competitive, then of course.

Bruce Feinberg, DO: All right. Anyone else want to weigh in? If it’s strictly a price story, then the question is, how close a price parity?

Bhavesh Shah, RPh, BCOP: These companies have enjoyed exclusivity for such a long time, right? It’s not fair that the health care system, the patients and the insurance companies actually pay for the increase in price. For a Genentech drug that you talked about, when they actually increased the price of that drug in 2 years, it resulted in almost a $1 billion increase to the health care system. That would have never been resolved if we didn’t have a biosimilar coming through. They would have to come down to the level.

Bruce Feinberg, DO: That was my reason for asking.

Kathy W. Oubre, MS: We have had that conversation, and the answer within our organization is that certain originator companies had their chance to be good partners. Some chose to; some chose not to. To your point, we will not be going back to certain originator manufacturers because we’re looking at that much larger picture, even with a parity contract. We believe in the science and the innovation behind the whole biosimilar market.

Bruce Feinberg, DO: I am feeling like Chuck Todd on Meet the Press, and this is making the nightly news. Thank you, Kathy. We just did that. That was great. I think it’s realistic, and the candor is so important for the audience to understand that this is a complex issue.

Karina Abdallah, PharmD: I’d like to add the point that we made earlier about infliximab versus oncology biosimilars. What happened in the infliximab space was that the originator product came out, dropped its price really low, and dangled that in front of a lot of payers and health systems. Some did choose to take that early on, saying, “Let me get this cost savings right away in year 1,” and some chose to wait it out. I do think it’s a bit of both, and it depends on the financial situation of the decision maker at that point in time.

Michael Diaz, MD: This is a really complicated subject. We always look at it from this perspective: how can we add the most value to the patient and the health care process? We’re seeing examples where, because of the larger rebates the originator product can provide—even though it’s a more expensive product for the patient—or the provider’s hands being tied, they have to give the originator product. That’s where it gets complicated so quickly. Each situation is not only unique but complicated.