Economic Feasibility of 'Pay One Price': An Analysis of Three Biosimilar Molecules with Different Prices and Indicated for Rheumatoid Arthritis in a Medium Size HMO
Author(s)
Francisco Prota, Ph.D1, Ricardo Bueno, BA, MHA, PhD2, Nanci Utida, MD3.
1Pontifical Catholic University of Campinas (PUCCAMP), CAMPINAS, Brazil, 2Graduate Program in Corporate Governance (MP-FMU), São Paulo, Brazil; Public Policy Program of School of Public Administration (DDPP-ENAP), São Paulo, Brazil, 3Assoc. Dir, Medical Affairs of Organon Brazil; Faculty of Public Heath USP, São Paulo, Brazil.
1Pontifical Catholic University of Campinas (PUCCAMP), CAMPINAS, Brazil, 2Graduate Program in Corporate Governance (MP-FMU), São Paulo, Brazil; Public Policy Program of School of Public Administration (DDPP-ENAP), São Paulo, Brazil, 3Assoc. Dir, Medical Affairs of Organon Brazil; Faculty of Public Heath USP, São Paulo, Brazil.
Presentation Documents
OBJECTIVES: To evaluate the feasibility of a “Pay One Price” pricing model for biosimilar agents used in rheumatoid arthritis (RA) treatment, focusing on Adalimumab, Infliximab, and Etanercept.
METHODS: The analysis used medication prices regulated by Brazil’s Chamber for the Regulation of the Medicine Market (CMED), a national reference for drug pricing. Biosimilar agents included Adalimumab, Infliximab, and Etanercept, with estimated usage percentages of 65%, 15%, and 20%, respectively, based on sales data. RA prevalence was estimated at 0.5% of the population, with 25% developing moderate to severe cases requiring biological therapy. The analysis considered a cohort of 100,000 patients, focusing exclusively on medication costs during the maintenance phase over one year.
RESULTS: From the estimated cohort, approximately 125 patients were eligible for biological therapy. Annual costs for the three biosimilar agents were calculated based on recommended dosages: Adalimumab cost $247.68 (3,000 doses/year), Infliximab cost $344.17 (1,500 doses/year for a patient weighing ~70 kg), and Etanercept cost $540.88 (6,500 doses/year). Considering these costs and their weighted usage proportions, the total costs per agent were $160.99 for Adalimumab, $51.62 for Infliximab, and $108.17 for Etanercept. The proposed “Pay One Price” model, calculated as a weighted average, resulted in a uniform price of $320.78 per dose. Annual expenditures totaled $157,895,469 under standard pricing and $139,322,188 with the “Pay One Price” model, leading to estimated savings of $18,573,281.
CONCLUSIONS: The implementation of the “Pay One Price” pricing model for biosimilars in RA treatment proved economically feasible. It reduces cost disparities between agents, optimizes overall healthcare spending, improves budget predictability, and ensures equitable access to effective therapies. Additionally, it supports better allocation of healthcare resources, benefiting both patients and healthcare systems.
METHODS: The analysis used medication prices regulated by Brazil’s Chamber for the Regulation of the Medicine Market (CMED), a national reference for drug pricing. Biosimilar agents included Adalimumab, Infliximab, and Etanercept, with estimated usage percentages of 65%, 15%, and 20%, respectively, based on sales data. RA prevalence was estimated at 0.5% of the population, with 25% developing moderate to severe cases requiring biological therapy. The analysis considered a cohort of 100,000 patients, focusing exclusively on medication costs during the maintenance phase over one year.
RESULTS: From the estimated cohort, approximately 125 patients were eligible for biological therapy. Annual costs for the three biosimilar agents were calculated based on recommended dosages: Adalimumab cost $247.68 (3,000 doses/year), Infliximab cost $344.17 (1,500 doses/year for a patient weighing ~70 kg), and Etanercept cost $540.88 (6,500 doses/year). Considering these costs and their weighted usage proportions, the total costs per agent were $160.99 for Adalimumab, $51.62 for Infliximab, and $108.17 for Etanercept. The proposed “Pay One Price” model, calculated as a weighted average, resulted in a uniform price of $320.78 per dose. Annual expenditures totaled $157,895,469 under standard pricing and $139,322,188 with the “Pay One Price” model, leading to estimated savings of $18,573,281.
CONCLUSIONS: The implementation of the “Pay One Price” pricing model for biosimilars in RA treatment proved economically feasible. It reduces cost disparities between agents, optimizes overall healthcare spending, improves budget predictability, and ensures equitable access to effective therapies. Additionally, it supports better allocation of healthcare resources, benefiting both patients and healthcare systems.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE244
Topic
Economic Evaluation
Topic Subcategory
Value of Information
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)