Bruce A. Feinberg, DO: The evidence is just so weak. In oncology, you could take examples of TKIs in renal cell carcinoma or chronic myeloid leukemia. Brandon, there are 5 competing drugs. You would think somebody would have flinched?
Hope S. Rugo, MD: Yes. You would think someone would make one cheaper.
Bruce A. Feinberg, DO: And even with drugs that only have less than a 10% market share versus the drug that’s the got the 50% market share, the price point is going to change.
Brandon Shank, PharmD, MPH, BCOP: If they find their niche, then they’re able to keep their price competitive. I was expecting, with the biosimilar Neupogen, filgrastim, that there would be more of a reduction in cost. I was expecting there to be a larger cost savings. I think the manufacturers may be upscaling the cost to bring it to the market. They might not be used to making these medications, and there might be some logistical challenges that add to the cost.
But, in regard to competition, I think contracting will help. From a pharmacy standpoint, this introduces the opportunity to have multiple contracts instead of 1 person at the table. From the pharmacy side, having multiple contracts should enable us to help contract a lower price, to hopefully in a hospital save some money.
Hope S. Rugo, MD: It’s a good point. The production standards are so great for biosimilars that you can have an agent that met all of the criteria but, then, has to completely step up and change the production facility, which is very costly. I wouldn’t pretend, in any way, to understand cost structuring, reimbursement, or what kind of money people are making from these drugs. It’s a big challenge, right now. But, I think there may be a difference when we think about, for example, 3 cyclin-dependent kinase inhibitors for breast cancer that all cost about the same amount. Those are drugs in which there is already another drug on the market. Now you’re getting new approvals of other agents. There’s no reason to compete on cost, and it’s controlled by a variety of regulatory mechanisms. Once you get to biosimilars like generics, you can really change the structure quite a bit. I know that some of the groups that make the originator product are thinking, “Well, maybe we’ll package 2 antibodies together or give it subcutaneously, so that we can actually still have the advantage, and we’ll price it lower at the same time.” So, it’s going to be complex, but maybe it will still allow for greater competition and pricing differences.