Biosimilars Available for 3 Drugs Costing More Through Hospitals, Physicians

SAP Partners | <b>AHIP</b>

AHIP released a report looking at the price markups for 10 drugs that can be delivered more affordably through specialty pharmacies, including 3 drugs with multiple biosimilars available.

Drugs administered in a hospital or physician’s office can cost up to twice the amount as the same drugs dispensed in specialty pharmacies, according to a new report from AHIP.

Researchers analyzed the cost of 10 drugs that are purchased, stored, and administrated in a hospital office or physician’s office but can also be safely and securely delivered through a specialty pharmacy. Among the 10 drugs evaluated are 3 that have multiple biosimilars available.

On average, drugs administered in physicians’ offices cost $1400 more and the cost per single treatment in hospitals were an average of $7000 more than those purchased through specialty pharmacies. Hospitals charged, on average, 108% higher prices for the same drugs as specialty pharmacies and physician offices charged 22% higher.

Of note, the drug cost estimate in physician offices and hospitals did not include the cost of administering the drugs. In addition, while the markup amounts were estimated for a single treatment, all of the 10 drugs evaluated require multiple treatments.

“Specialty pharmacies lower a patient’s health care costs by preventing hospitals and physicians from charging exorbitant fees to buy and store specialty medicines themselves,” the authors wrote in the report. “Secure, direct delivery is more efficient and effective and reduces health care costs.”

The researchers identified the 10 drugs evaluated utilizing the list of top 25 drugs by spending in Medicare Part B in 2019 as well as consultation with AHIP’s member plans on the drugs commonly delivered through specialty pharmacies. They used medical and pharmacy claims data from the IBM MarketScan Commercial Database from January 1, 2018, to December 31, 2020 and calculated the 3-year average cost for a single treatment for each of the 3 settings.

The 3 drugs reviewed with biosimilars were:

  • Herceptin (trastuzumab, Genentech), which has 5 biosimilars available in the United States
    • Kanjinti, approved June 2019 and launched July 2019 from Amgen/Allergan
    • Ogivri, approved December 2017 and launched December 2019 from Viatris/Biocon
    • Ontruzant, approved January 2019 and launched April 2020 from Organon/Samsung Bioepis
    • Herzuma, approved December 2018 and launched March 2020 from Celltrion/Teva
    • Trazimera, approved March 2019 and launched February 2020 from Pfizer
  • Remicade (infliximab, Janssen Biotech), which has 4 biosimilars approved in the United States, but only 3 on the market
    • Renflexis, approved May 2017 and launched July 2017 from Organon/Samsung Bioepis
    • Avsola, approved December 2019 and launched July 2020 from Amgen
    • Inflectra, approved April 2016 and launched November 2016 from Celltrion/Pfizer
    • Ixifi, approved December 2017 from Pfizer, which has chosen not to market this product in the United States to avoid competition with Inflectra
  • Rituxan (rituximab, Biogen/Genentech), which has 3 biosimilars available in the United States
    • Truxima, approved November 2018 and launched November 2019 from Celltrion/Teva
    • Riabni, approved December 2020 and launched January 2020 from Amgen
    • Ruxience, approved July 2019 and launched January 2020 from Pfizer

Other drugs reviewed were Botox (onabotulinumtoxinA), Keytruda (pembrolizumab), Ocrevus (ocrelizumab), Opdivo (nivolumab), Prolia (denosumab), Tecentriq (atezolizumab), and Xolair (omalizumab). The indications covered by all 10 drugs covered the gambit, including various cancer indications, chronic migraine, multiple sclerosis, osteoporosis, psoriasis, Crohn disease, rheumatoid arthritis, and asthma.

Prolia had the largest markups, on average 215% in hospitals and 49% in physicians’ offices, compared with specialty pharmacies. The smallest hospital market was 76% for Xolair and the smallest physicians’ office markup was 7% for Rituxan.

“The data are clear, specialty pharmacies lower patient costs by preventing hospitals and physicians from charging patients, families, and employers excessively high prices to buy and store specialty medicines themselves,” Matt Eyles, president and CEO of AHIP, said in a statement. “Secure, direct delivery is a safe and smart competitive alternative that improves affordability and access for everyone.”