More Details on Coherus Bioscience’s Udenyca Launch

Go big or go home, seems to be the message of Coherus’ President Dennis Lanfear. At the JP Morgan Investor Conference yesterday in San Francisco, he outlined what he considers a “full-on branded launch” for the biosimilar maker’s key product. Udenyca was officially launched on January 3.

In preparation for the launch of Udenyca, Coherus Bioscience secured $75 million in financing to shore up its cash position and to support its marketing effort.

Udenyca launch

The First Payer Deal for Udenyca

More than half of the current pegfilgrastim claims are reimbursed by commercial payers, with Medicare accounting for an additional one-third. Mr. Lanfear announced a couple of important payer developments that should benefit sales immediately. He said that Coherus “inked a deal with Anthem Blue Cross Blue Shield last week,” but did not elaborate on the terms. Although he alluded to a press release on Coherus’ website, none had been posted at the time of this writing. He also mentioned that Aetna and Blue Cross Blue Shield of South Carolina had independently begun “requesting Neulasta users to step through Fulphila or Udenyca before filling those claims.”

The group purchasing organization (GPO) market “is highly focused,” said Mr. Lanfear. “About a dozen players account for 95% of the market. 340B hospitals represents around $963 billion in annual revenue. Vizient accounted for $824 million in Neulasta sales last year (about 35% of the non-340B market), and welcomed us to the market.”

Targeting the Greatest Pegfilgrastim Market Opportunities

He believes, “Biosimilars with pass-through status can provide significant value in non-340B settings. They may be the lowest price side of the market, but most motivated.” According to Mr. Lanfear, these facilities’ efforts at cost recovery is expected to drive the market.

Udenyca and Fulphila are priced identically at $4,175 or at a 33% discount to Neulasta Udenyca’s 33% WAC discount per syringe to avoid payer disincentives. Specifically, after discounting and rebates, Amgen’s ASP for Neulasta was $4,422, which gives the payer an immediate ASP discount. In previous biosimilar launches, their manufacturers’ smaller discounts had actually resulted in higher ASP costs than the reference product. In those cases, payers were reluctant to encourage biosimilar use, at least until the biosimilar had sufficient time in the marketplace where its own ASP could be calculated. “Having our unique HCPCS code results in an ability to control our own ASP,” said Mr. Lanfear. This is the direct result of the current administration’s efforts to fix the original J-code rule.

Further, he believes that Coherus can take advantage of Udenyca’s reimbursement opportunity in the buy-and-bill sector. At present, Neulasta is reimbursed at ASP – 22.5%. [Non-340b] pass-through status will be designated in April 1, 2019, and Udenyca will be reimbursed at ASP + 6% for at least 2 years from that date. (Fulphila currently has pass-through status). This prevents biosimilars from being disadvantaged from the provider perspective.

A National and Regional Sales Structure

To support the new launch, Coherus has created a formidable sales force and structure, including:

  • 67 Oncology account managers
  • 7 Regional sales directors
  • 7 Key account directors
  • 7 Field reimbursement specialists
  • 7 Medical science liaisons
  • 3 Group purchasing directors
  • 4 Payer directors

Mr. Lanfear believes that creation of this extensive sales organization has not been done before with a biosimilar. And he emphasized that they expect to leverage this salesforce infrastructure for its pipeline products, including biosimilar adalimumab, biosimilar ranibizumab, biosimilar aflibercept, and a small-molecule treatment for nonalcoholic steatohepatitis (NASH).

Coherus has ramped up its production, to be able to handle demand from all its customers, and it has used the LASH Group to develop the Coherus COMPLETE support site for patients and providers.

Coherus’ plan for a “branded-type” launch for its biosimilar pegfilgrastim seems to afford benefits in pricing, sales, supply, and services. We await news of their progress.

Udenyca to Launch January 3, Same WAC as Mylan’s Fulphila

Coherus Biosciences surprised many on its third-quarter earnings call late yesterday. It will rely not on a lower price than its biosimilar competitor to gain marketshare after Coherus’ Udenyca launch, but on its ability to pull through on its patient and provider services and supply chain to gain significant marketshare for its biosimilar version of Neulasta®.

This is not to imply that Coherus will not offer contracts to group purchasing organizations (GPOs), hospitals, and payers.  The company intends to do so. However, the wholesale acquisition cost (WAC) for Udenyca® will match that of Mylan’s Fulphila®—$4,175 per vial, or a 33% discount from Amgen’s reference product. Denny Lanfear, CEO of Coherus added that the company’s contracting plans “will deliver additional value to payers.”

Jim Hassard, Coherus

AWAITING HCPCS CODING

Unlike other biosimilar manufacturers, this is their first product to reach the market. Not only was manufacturing and production a priority, but company infrastructure had to be ready for launch. Although Coherus pointed out that the sales force for Coherus is fully in place, they are holding back the Udenyca launch until the Center for Medicare and Medicaid Services (CMS) designates a Q code for claims and billing purposes. Therefore, the goal is a Udenyca launch date of January 3, 2019.

Jim Hassard, Vice President for Marketing and Market Access, emphasized that “Our overall launch strategy goes beyond pricing, to reliable supply and services. We’re committed to world-class execution and salesforce effectiveness.” The company’s Coherus Complete, patient and provider service site, is operational, and this will include copay support for eligible patients. Mr. Hassard stated, “This price is attractive to payers without diminishing our value proposition. We can deliver significant savings to the health system versus Neulasta.”Coherus Biosciences

CAN UDENYCA GRAB SOME ONPRO MARKETSHARE?

One interesting statement made during the call was the expectation that Coherus will go after some of Neulasta Onpro’s share of the market. Amgen’s on-body injector accounts for about 60% of all Neulasta utilization today, “but this growth has flattened out,” Chris Thompson, Vice President of Sales, emphasized. “We’re looking at the whole market, not just prefilled syringe market,” he said. “We think we’ll be able to sell through the Onpro market,” meaning that their pricing and services will attract some of this marketshare. In fact, Coherus executives believe that biosimilars may eventually garner nearly 70% of the pegfilgrastim market.

Coherus believes that there is pent-up demand for the biosimilar in the hospital segment today, which is why GPOs may represent promising contracting opportunities. They are seeking parity positioning at the payer and pharmacy benefit manager level.

This sounds fairly reasonable. Yet the vast majority of biosimilar consultants and payers with whom I had communicated had anticipated that Coherus would launch with at least a modest WAC discount relative to Mylan’s Fulphila. On the conference call, the investment banking participants wanting information on the Udenyca launch seemed caught off guard as well.

UDENYCA REVENUE TO SUPPORT COHERUS FOR NOW

Perhaps this strategy gives Coherus ample room for contracting while retaining a respectable net cost. Mr. Thompson said, “We’ll roll out a comprehensive contracting strategy for GPOs in the next week or two. It will be competitive and designed to win.”

It may need to be. Relying on better services and perhaps even a better supply chain (albeit one that is brand new) may not be sufficiently persuasive to hospital and payer P&T Committees. And Coherus needs to generate revenue from its sole product to feed its new sales team, new product development, and hungry investors.

Coherus Gets FDA Approval for Its Pegfilgrastim Biosimilar

With the Food and Drug Administration (FDA) approval today of Coherus Bioscience’s Udenyca™ (pegfilgrastim-cbqv), the second pegfilgrastim to compete with Amgen’s Neulasta®, much attention will be now focused on the company’s November 8 earning call.

The FDA approved Udenyca on the basis of a supportive analytical similarity package, but with phase 1 data only. Over 600 healthy subjects were given the agent to test its pharmacokinetic, pharmacodynamic, and immunogenicity safety.

We should learn a great deal by the end of the week about the nature of the competition for the injectable pegfilgrastim marketplace into 2019. In the press release announcing the approval, the company said it will reveal its launch plans, including pricing, during its week’s call. On Monday, November 5, we should hear the first information about whether Mylan’s first-to-market entry, Fulphila®, has gained some traction against the injectable form of Neulasta. Mylan launched Fulphila at the end of July.

In a previous post, we discussed how Amgen’s Neulasta Onpro® patch has already captured upwards of 80% of the pegfilgrastim business. Because of the convenience of the patch formulation, it would be surprising if Onpro’s share of market eroded significantly. However, Amgen must ensure that the net cost difference between the biosimilars and Neulasta Onpro is not noteworthy. Otherwise, payers’ can be expected to try to disadvantage Onpro through step edits or greater patient cost sharing. That would take a sizable bite out of Amgen’s large slice of the $4 billion pegfilgrastim pie.

The FDA approved Udenyca for the following indication: to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia. It was not approved for the mobilization of peripheral blood progenitor cells for hematopoietic stem cell transplantation. This indication language does not differ from that for Fulphila. Neulasta has the additional indication of increasing survival in patients acutely exposed to myelosuppressive doses of radiation.

Undenyca was also approved for sale in the EU, although Coherus has not launched there, awaiting a marketing partner.