Stelara Biosimilars Begin to Launch, Showcasing (Again) the Weirdness of a System that Doesn’t Reward Low Prices

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Well, this is suspicious. 

Antonio Ciaccia, the guy behind 46Brooklyn and 3 Axis Advisors, is the subject of a hit piece in the Washington Examiner. The story goes into great detail about some convoluted money flows that allegedly show that he’s in the pocket of big pharma. 

That conclusion doesn’t hold up to reality, but that’s not really the point. 

The point is that there is clearly some sort of coordinated effort to go after Antonio. I mean, if this was a considered take on whether Antonio was hopelessly biased against one side of a debate, there would be a lot more analysis of Antonio’s methods and conclusions. 

But there’s not a single word in the piece calling into question the actual work. It’s all innuendo. And it’s not like Antonio doesn’t show his math and his data. Heck, if anything, Antonio overshares. 

So that raises the question: What’s going on here? 

That’s not a very hard question, if we’re being honest. 

Antonio has been embarrassing the PBMs for years, making sound, data-driven arguments that strange things are afoot. He laid the groundwork for a lot of analysis that the FTC has done. (Indeed, PBMs tried to subpoena Antonio’s emails in their legal battle with the FTC.) He’s been responsible for the foundation of the anti-spread-pricing movement. His takedown of a PBM-sponsored report defending the industry’s business model was so effective that the report was taken down and re-issued. 

So it’s not hard to see that he’d be a target. 

Unsurprisingly, the Washington Examiner piece -- written by a reporter who is steeped in ideological warfare, not the pharmaceutical supply chain -- was almost instantly shared on social by a United exec, which is almost certainly a tell. 

There was also an immediate “ICYMI” post about the Examiner story from a shadowy anti-pharma group that gets zero social engagement but has the resources for a big advertising spread in Axios. Your premium dollars at work!  

Look, I get that all is fair in love PBM business models and war, but if you want to go after Antonio, you’d better bring receipts, based on the hundreds and hundreds of pages of his work. Smear campaigns are not going to cut it. 

If this is how the PBMs want to handle Antonio, then their arguments may be weaker than I thought. 

Most Americans have the vague sense that the pharmaceutical market is rigged against them. And they’re right, though not always in the way that they think. 

This week brings another example: the market for biosimilars of Stelara, an immune-targeted therapy for inflammatory diseases, is about to explode with new entrants. Sterala did about $6.7 billion in sales last year, so its loss of exclusivity is not insignificant in terms of dollars. 

And yet if you look at the prices for the biosimilars, the range is wild. Here are the costs for various competitors. (The details here come from Andrew Bourgoin’s indispensable All Things Biosimilar. This is for the 90 mg dose): 

• Stelara (brand name): $29,151

• Wezlana (high list): $27,564

• Wezlana (low list): $5,568

• Steqeyma: $4,176

• Yesintek: $3,000

There’s a lot to unpack here. For starters, Wezlana is made by Amgen but is being sold by Optum’s Nuvaila unit, part of the weird white-labeling-by-big-insurers trend. (There is another biosimilar coming from Quallent/Express Scripts/Cigna, but I don’t have the pricing details. I assume CVS/Cordavis will also play along, but I don’t have details there, either.)

The two-price thing has traditionally been a way to offer a high-list, high-rebate offer to rebate-addicted plans while also offering a low-list-price option. What’s a little wild here is that even the low-list version of Wezlana is nearly twice the price of Yesintek. 

It’s a reminder that plans are still looking for big rebates and that the lowest-price option is not necessarily the one that the market is choosing. This makes sense if you look at individual incentives throughout the supply chain. 

But it makes zero sense if you’re a patient. 

• I’m late on this, but executives discussing the IRA outside of the context of earnings calls is so rare that I didn’t want it to slip by: here is UCB’s Jed Perry, the head of U.S. public policy, on (among other things) the IRA: “We support the ORPHAN Cures Act, which aims to amend the IRA to ensure orphan drugs treating one or more rare diseases or conditions are excluded from Medicare price negotiations, which would support investment into orphan drug development.” I know it doesn’t sound revolutionary, but the reality is there aren’t that many companies on the record with this kind of legislation. 

• Yesterday, I noted several reporters who have put out public calls for people to tell their stories about firing and research at risk. You can add Ed Silverman from STAT to that list. Here’s to sunlight. 

Cost Curve is produced by Reid Strategic, a consultancy that helps companies and organizations in life sciences communicate more clearly and more loudly about issues of value, access, and pricing. We offer a range of services, from strategic planning to tactical execution, designed to shatter the complexity that hampers constructive conversations. 

To learn more about how Reid Strategic can help you, email Brian Reid at [email protected].