A recent study published in JAMA found that as the acquisition prices of bevacizumab, rituximab, and trastuzumab fell from 2020 to 2024, hospitals’ profits on each biosimilar purchase increased, and the uptake of these oncology biosimilars rose quickly. This could be an important lesson for the upcoming Keytruda and Opdivo biosimilar launches.
Researchers from the University of California, Berkeley and Brown University found that for the oncology therapies bevacizumab, rituximab, and trastuzumab, hospitals profited handsomely from the use of biosimilars over their reference products. Their study was published March 11 in JAMA.
The overall biosimilar uptake of these three products has been a model for the rest of the biosimilar industry in that uptake was rapid (achieving >60% utilization by year 3) and > 60% average sales price (ASP) declines occurred over four years. These biosimilars first entered the market in 2019. According to the Samsung Bioepis Biosimilar Trend Report, ASPs have now dropped below $1,000 for several biosimilars in all three drug categories, with the most extreme drop for Trazimera, a biosimilar of trastuzumab, at an ASP of $112 per 420 mg dose. Biosimilar uptake is over 85% for the bevacizumab and trastuzumab categories and at 78% for rituximab.
Biosimilar Acquisition Prices Dropped, Hospital Profit Rose
The researchers collected data from Blue Cross Blue Shield health insurance plans that contained drug acquisition costs, drug reimbursements by the insurers, hospital eligibility for 340B discounts, and other information from 2020 to 2024. The database covered more than 66,000 patients who received oncology biologics and biosimilars in more than 1500 hospitals.
They found that the biosimilar acquisition prices paid by the hospitals to manufacturers (or intermediaries) declined by 60% for bevacizumab, 72% for trastuzumab, and 63% for rituximab over that period. However, reimbursements from insurers declined only by 32%, 36%, and 34%, respectively, resulting in additional profit for the hospital systems.
With the increased profit from these three oncology biosimilar categories, the hospitals increasingly favored the biosimilars over the reference biologics. From 2020 to 2024, hospital uptake of bevacizumab jumped from 32% to 93%. Similar leaps were seen for trastuzumab biosimilars (from 37% to 87%) and for rituximab biosimilars (from 18% to 84%).
These figures would seem counterintuitive, if one considers the pervasive 340B discounts used by hospital systems for outpatient drugs. The authors assumed a 340B discount of 65% of the ASP price. If that is factored in, it would make most sense for the hospital system to purchase at the low 340B price, and seek reimbursement from insurers at the higher price, further widening their profit on each drug utilized. The researchers found that “Hospitals eligible for federal 340B acquisition price discounts were associated with a lower probability to adopt biosimilars than noneligible hospitals for trastuzumab and rituximab.” They also found that “for-profit hospitals were associated with higher probability of biosimilar use for trastuzumab and rituximab.
The study authors believe that gainsharing or shared-savings payment methodologies by Medicare accounted for the overall preference for biosimilars. These gainsharing payment methods, they assert, have also become popular in the private sector as well.
This experience may well be applied to the new oncology biosimilars that will be introduced for Keytruda, Opdivo, and others over the next two to three years.
In Other Biosimilar News
Celltrion announced that its tocilizumab biosimilar (Avtozma) has been launched in the US, marking the first intravenous and subcutaneous biosimilar interleukin-6 receptor antagonist. It is one of three Actemra biosimilars approved in the US.
This article was written by our Director of Content, Stanton Mehr. Stan has been writing commentary and reporting news about the biosimilar industry since the submission of the first biosimilar 351(k) application to the FDA 13 years ago. Since that time, BR&R has been tracking the US biosimilar marketplace, with the industry’s original, comprehensive and updated database of biosimilar filings with the FDA.
