Biologics' net prices decrease with biosimilar competition
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The net prices of four biologics — filgrastim, pegfilgrastim, infliximab and insulin glargine — all decreased in the face of competition from biosimilars or other substitutes, even without interchangeability, according to findings published in JAMA Network Open.
“Biosimilar prices are estimated to be 15% to 16% lower than originator products, but it is unclear how list prices, net prices and discounts for the originator products change with biosimilar competition,” Alvaro San-Juan-Rodriguez, PharmD, of the University of Pittsburgh School of Pharmacy, and colleagues wrote.
To analyze how the net price of these four biologics changed with the introduction of competition from biosimilars or other within-molecule substitutes, San-Juan-Rodriguez and colleagues studied pricing data from SSR Health. According to the researchers this database provides estimates of list prices, net prices, Medicaid discounts and discounts regarding other payers for branded products with the United States, as reported by publicly traded companies.
Focusing on the time period from January 2007 to June 2018, the researchers defined quarterly net prices as the ratio between sales and the number of units sold, while discounts were calculated as the ratio between the difference in list and net prices and the list prices. Net prices and discounts account for all manufacturer concessions, including but not limited to rebates. San-Juan-Rodriguez and colleagues calculated the mean list and net prices, and the mean discounts in Medicaid and other payers, for each drug and year.
According to the researchers, list and net prices of filgrastim (Neupogen, Amgen) increased in parallel each year by a mean of 5.1% (95% CI, 4-6.2) and 6.1% (95% CI, 3.7-8.4), respectively, until the introduction of its first biosimilar in 2015. Subsequently, list prices flattened, and net prices began to decrease by a mean of –7.7% (95% CI, –19.9 to 4.6) each year. In addition, list and net prices of pegfilgrastim (Neulasta, Amgen) increased annually by a mean of 7.5% (95% CI, 6.2-8.8) and 4.9% (95% CI, 1.3-8.5), respectively, until the introduction of its first biosimilar in 2018. At that point, list and net prices decreased by –7.4%.
Infliximab’s (Remicade, Janssen) list and net prices each increased in parallel by a mean of 6% from 2007 to 2013. Then, in 2013, net prices started to decrease by a mean of –1.3% (95% CI, –9.7 to 7.2) annually. This price reduction accelerated to a mean of –13.6% (95% CI, –19.7 to –7.5) annually after its first biosimilar entered the market in 2017.
Insulin glargine’s list and net prices of increased annually from 2007 to 2014 by a mean of 14.7% (95% CI, 7.1-22.3) and 8.8% (95% CI, 1.9-15.6), respectively. Then, from 2015 to 2019, list price growth slowed to an annual mean of 5.8% (95% CI, 0.4-11.2). Its net price decreased by a mean of –14.4% (95% CI, –21.1 to –7.7) annually in 2015, then accelerated to a mean of –23.5% (95% CI, –31.2 to –15.7) following the introduction of its within-molecule substitute in 2017.
Medicaid discounts increased by 20.1 (95% CI, 19.4-20.7) percentage points for filgrastim, by 31.2 (95% CI, 30.9-31.5) for pegfilgrastim, 33.8 (95% CI, 33.1-34.4) for infliximab and 35.2 (95% CI, 34.2-36.2) for insulin glargine, across the study period. For non-Medicaid payers, discounts increased by 20.3 (95% CI, 12.1-28.5) for filgrastim, 23.4 (95% CI, 15.6-31.2) for pegfilgrastim, 50.6 (95% CI, 49.4-51.7) for infliximab and 76.1 (95% CI, 74.1-78.1) for insulin glargine.
“In 4 case studies, we observed that the net prices of originator biologics decreased following the entry of biosimilars or other substitutes,” San-Juan-Rodriguez and colleagues wrote. “For infliximab and insulin glargine, decreases in net prices had commenced 2 to 3 years before the commercialization of competitors; however, decreases further accelerated following competitor entry.”
“Decreases in net prices were primarily due to increases in manufacturer discounts, specifically in payers other than Medicaid,” they added. “While the decreasing net prices of infliximab and filgrastim had been previously described, our study is the first, to our knowledge, to examine pegfilgrastim and insulin glargine and the contribution of non-Medicaid discounts toward lowering net prices.” – by Jason Laday
Disclosure: The researchers report funding from the Myers Family Foundation. Researcher Inmaculada Hernandez, PharmD, PhD, of the University of Pittsburgh School of Pharmacy, reports personal fees from Pfizer, as well as advisory board membership with Apixaban.
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