OBJECTIVES: Previous research reported factors contributing to positive recommendations by the Agency for Care Effectiveness (ACE), including price.¹ This study explored the impact of generics/biosimilars on branded drug listing decisions in Singapore. METHODS: All appraisals published by ACE (March 2017–May 2019) were reviewed; those including comparisons of branded drugs to generics/biosimilars were included for analysis. Where inclusion of generics/biosimilars was uncertain, the appraisal was excluded. RESULTS: Amongst 39 appraisals reviewed, 19 compared branded drugs to generics/biosimilars. Generics/biosimilars were favoured in 12/19 appraisals (8/15 generics; 4/4 biosimilars) on the basis of price or cost-effectiveness. These included appraisals that awarded subsidy listing to the generic (n=3) or biosimilar (n=2), or to the generic in addition to the branded drug (n=1), as well as appraisals where subsidy listing was not awarded to the branded drug as this was compared to a generic (n=4) or biosimilar (n=2) that was available or anticipated to be available. Clinical need for different dosages allowing dose titration was cited as the reason that both generic and branded mycophenolate (500mg tablet and 250mg capsule, respectively) were listed for lupus nephritis. Listing of a biosimilar resulted in de-listing of the originator in one appraisal (Remsima vs. Remicade). Amongst 7 appraisals that favoured the branded drug, subsidy listing was awarded to 5 branded drugs as it was cost-effective compared to the generic comparator. In only 2 appraisals, cost-savings or cost-effectiveness associated with the generic were outweighed by other factors: the risk of dispensing errors for another indication (omalizumab vs. generic ciclosporin) and administration benefits reducing caregiver burden (rivastigmine patch vs. generic oral donepezil). CONCLUSIONS: While low-cost generics/biosimilars have accelerated patient access to treatments in Singapore, the emphasis on costs in drug listing decisions may limit patient choice or disincentivise manufacturers from bringing innovative medicines to Singapore. REFERENCES: ¹Ghosh W et al.Value in Health.2018;21(Suppl.2):S9.