Will biosimilar manufacturers and patient access somehow benefit from the COVID-19 pandemic? I am having some trouble following the logic of those who believe it will. If people who cannot afford their medications when economic conditions decline, they may not be in a better situation to afford biosimilar versions of biologic medications, especially if their insurers don’t dramatically lower cost sharing for these biosimilars.
Payers who do want to lower patient cost sharing may be struggling to achieve this based on pharmaceutical contracts that are currently in force. In other words, they may not be able to rapidly lower coinsurance for biosimilars if the reference agent is guaranteed preferred access.
On the other hand, there is some evidence that biosimilar utilization has actually taken a hit during the COVID-19 pandemic. The most recent report from Bernstein Research shows this to be the case in one biosimilar drug category, and the logic behind this trend is easy to understand.
The COVID-19 Effect
With three marketed biosimilars (and another only recently approved) and two reference product formulations, pegfilgrastim is an extremely competitive drug category. One can even add the short-acting products (filgrastim) to the market basket to further complicate the picture. Out of this busy dynamic, a few trends have been obvious (and reported on):
- Coherus Bioscience’s Udenyca® has been steadily gaining marketshare
- Amgen’s reference product Neulasta® (the original syringe form) has been steadily losing marketshare
- Utilization of Neulasta’s OnPro® on-body injector (the dominant player at > 55%) has been relatively steady
- The other biosimilar products (Fulphila® and Ziextenzo®) have not yet gathered momentum
Bernstein’s analysts do note that oncology utilization overall has contracted somewhat with the onset of the COVID-19 pandemic. Therefore, these figures should be considered in the context of less oncology drug use across categories.
However, as recently as January 2020, Coherus reported that Udenyca’s US marketshare climbed to above 20%, and Bernstein Research’s analysis show that this reached 22% in March in the pegfilgrastim category. Something happened to the April figures, however, which gave the analysts pause. Udenyca’s momentum stopped dead. It lost two percentage points in terms of share, a 10% drop in one month, whereas Neulasta OnPro gained more than 3.5 percentage points, a 7% increase. Use of the other biosimilars remained the same or fell slightly, and utilization of Neulasta syringes continued its decreasing trend unabated.
This does make sense if viewed from the perspective of patient care in the COVID-19 pandemic environment. People do not want to visit health facilities or physician offices unnecessarily. Patients who are undergoing chemotherapy for the treatment of cancer are immunocompromised and at high risk.
The use of an on-body injector allows patients undergoing chemotherapy to skip at least a couple of in-person visits to the infusion center without exposing them to higher risks of neutropenia and infection. Therefore, use of on-body injector technology seems to be a reasonable choice. Unfortunately, pegfilgrastim biosimilars are only available for administration by syringe at this time.
Whether this becomes a longer-term trend may well depend on the duration of the pandemic crisis. The market penetration data released by Bernstein Research does not yet capture May or June figures, and the release of the newer data should help validate or debunk this theory. It does potentially represent how an unusual factor can affect biosimilar uptake trends.