When a Biosimilar Might Increase Not Decrease Costs | Ravi Parikh, M.D., M.P.H., ASRS 2023

The approval of an ophthalmic bevacizumab biosimilar might mean the end of low-cost, repackaged Avastin as an anti-VEGF treatment for retinal diseases, with the unintended consequence of adding $457 million to Medicare B spending, says Ravi Parikh, M.D., M.P.H., a retinal specialist in New York.

Biosimilars are supposed to act as a counterweight to the high prices of the biologics.

But if a biosimilar to ophthalmic bevacizumab is approved, the effect may be just opposite, according to Ravi Parikh, M.D., M.P.H.

Parikh, a retina specialist in New York and director of healthcare delivery research for the Department of Ophthalmology at NYU Grossman School of Medicine, spoke about this apparent paradox today at the American Society of Retina Specialists (ASRS) annual scientific meeting in Seattle.

If the ophthalmic bevacizumab biosimilar is approved and then priced at $500 per 1.25 mg dose, Parikh and his colleagues have calculated that costs to Medicare B would increase by $457 million, from $3.01 billion to $3.47 billion, and that cost burden on patient would increase by $117 million, from $768 million to $884 million,

In an interview with Managed Healthcare Executive that was recorded before the ASRS meeting, Parikh explained that the 2013 Drug Quality and Security Act prohibits compounding an approved drug. As a result, were Outlook Therapeutics’ Lytenava (bevacizumab-vikg) to be approved and put on the market, then that prohibition would presumably apply to the Avastin (bevacizumab) that is being repackaged from larger doses for cancer treatment into smaller doses for the eye.

“Our research hopes to highlight the need for an exemption (to the Drug Quality and Security Act) so patients don’t lose access to a low-cost option,” he said. Parikh said he couldn’t speak for ASRS but he knows many members who are concerned about low-cost, repackaged Avastin no longer being available as an unintended consequence of the biosimilar approval.

Parikh said that even in the unlikely event all the patients treated with Lucentis (ranibizumab) and Eylea (aflibercept) were switched to less expensive biosimilars, that would offset only 30% of the cost increases associated with the cost hike from low-cost, repackaged Avastin no longer being available.