Drug pricing and the 80/20 rule

According to an analysis conducted by Blue Cross Blue Shield, “expensive branded drugs” accounted for 79% of prescription spending while accounting for just 17% of the prescriptions written. The largest contributors to the 17% came from just 3 drugs: Humira, Remicade, and Enbrel. See a trend? These are all biologic treatments for rheumatoid arthritis (with some Crohn’s Disease sprinkled in). “No sh!+,” said this writer’s mother-in-law who has RA and can’t afford treatment. There are more expensive drugs on the market than these 3 but they tend to treat smaller populations than those with RA and Crohn’s. To be fair (and intellectually honest), the BCBS analysis doesn’t include the impact of rebates, which you just learned 2 articles ago is a big deal. Don’t you retain anything you read? Here’s a list of the top 10 most expensive drugs in the US. Yikes!

Do you take drugs Danny? Everyday.

Apparently so does everyone else. For a video presentation of the top 20 selling drugs for 2017, see this. Warning, the presentation is titled “best selling drugs in 2018.” See the disconnect? While InsightCity does not have Carnac skills, others might. Anywho. Drug #20 (Stelara) generated ~$4B in sales while #1 (Humira) generated ~$18B. Not too shabby. What’s really interesting is that Humira is off-patent and the FDA has approved two, yes two, biosimilars. How has AbbVie continued to increase sales of Humira after patent expiration? In a word, legalese. According to Jefferies analyst Ian Hilliker, “the fact that a 2nd biosimilar developer has given up on litigating Humira in favour of a settlement helps to underpin the strength of AbbVie’s Humira IP.” With a worldwide prescription drug market of ~$800B, it’s not only Danny Noonan that takes drugs every day.

Big changes for your RA, maybe

And no, we are not talking about the person that let you drink in your college dorm room. Earlier this week Boehringer Ingelheim announced the FDA has approved Cyltezo, a biosimilar to AbbVie’s Humira. A year ago, the FDA approved Amgen’s Amjevita, another biosimilar to Humira. Cyzelto was noted to be “highly-similar” to the reference product. Good for BI. The FDA said that Amjevita is not an interchangeable product for Humira and placed a Black Box warning on the product. Bad for Amgen. But wait, there’re more. It really doesn’t matter. AbbVie has launched several lawsuits, so despite the FDA’s approval, neither Cyltezo nor Amjevita are commercially available in the US. Here is what Amgen and BI are thinking now. Oh, what a tangled web we weave…

Not just for smokin’

Maybe tobacco can redeem itself for its bad reputation as being an addictive, cancer-causing vice. It turns out, a tobacco plant-based platform for biomanufacturing may be able to make monoclonal antibodies at just 10% of the cost it takes using mammalian cell line systems. PlantPraxis, a joint venture between the Brazilian company Axis Biotech Brasil and the Canadian biotech PlantForm Corporation, is breaking ground on a pilot production facility in Rio de Janeiro to aid in the development of a biosimilar for AbbVie’s Humira (adalimumab) in addition to other biologics in their pipeline. What is even better than saving tons of money? Saving time; and the plant-based platform can do that too, along with unlimited scale-up capabilities. Don’t sell the tobacco farm just yet…

4. Good week for biosimilars

This week, United Health announced a proposal to drop Sanofi’s insulin Lantus and Amgen’s bone marrow stimulant Neupogen in favor of their biosimilars. AND THEN, the FDA approved Amgen’s biosimilar version of Humira. Good week for biosimilars, bad week for Lantus, and meh week for Amgen (especially since AbbVie is still suing for patent infringement). This is only the fourth biosimilar licensed by the FDA under the Biologics Price Competition and Innovation Act, but the true test will come if more payers, like United, drop the branded products completely. ICYMI: Biosimilar safety and interchangeability are still questioned by some.