Biosimilars versus biologics: Is marketing madness on the way as biosimilar approvals balloon?

As copycats of complex biologic meds begin to swell into the market and look to unseat their original biologic counterparts, what does that mean for marketing? Will big ad-spending biologic drugmakers drop out of DTC marketing—and will biosimilars sweep in?

Like the biosimilar market itself, the answer is complicated.

Biologic drugmakers will likely decrease ad spending as biosimilar competition enters the market, but it won’t stop entirely. Biosimilars, on the other hand, with more limited budgets, will likely focus on physician and digital marketing spending in targeted ad approaches rather than big DTC campaigns.

One thing is certain, though. The biologic/biosimilar marketing trajectory departs from the traditional branded drug strategy when generic competition enters the market.

Today, when small-molecule brands fall off the patent cliff, so do advertising dollars. Take Pfizer’s pain med Lyrica. The drugmaker went from spending about $20 million per month on national TV ads in 2018 to literally zero dollars just one year later, right before it lost patent protection in June 2019.

That’s been the common path for brands and generics. Pfizer and Eli Lilly both dropped advertising for their respective erectile dysfunction drugs Viagra and Cialis in 2017 after generic competition entered the market.

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“Biosimilars still have an air of uncertainty around them in the U.S. market,” Jeff Greene, Intouch Solutions' vice president of strategic planning, said. “Patients and doctors value major (biologic) brands that have been in market for a long time and have all these value-add support services. Yes, they know they're expensive, but they work. Even though it looks like a no-brainer on paper—as soon as a biosimilar becomes available, everyone is going to switch—it's not that simple.”

Patients themselves are interested. In a WeGo Health quick poll run for Fierce Pharma, about half of the surveyed 50-plus autoimmune patients on biologics said they would consider switching to a biosimilar.

One patient who has considered a switch said, “I've asked my doctor about biosimilars after seeing ads for their availability as a replacement for Remicade. I've been on Remicade for 21 years and am seriously considering switching but haven't yet.”

When asked what kind of marketing messages would help convince them to switch, the majority chose efficacy, followed by safety and fewer side effects. Promoting doctor recommendations, financial support programs and patient testimonials were also mentioned as potential convincing ideas for new biosimilars.

The biosimilar competitive market is shaping up much differently than the generic one because, as Greene noted, the markets are similar only the surface.

Unlike generics, biosimilars are still expensive. The average cost break for a biosimilar over a biologic ranges only from about 10% to 20%, leaving plenty of profit for both the original biologic and the biosimilar to put toward marketing expenses.

Sharon Phares, Ph.D., senior VP at Pharmaceutical Strategies Group and co-author of a recent specialty drug report, said, “Biosimilars, while priced less expensively than the innovator brands typically, are still priced at enough of a cost to be able to spend some money on marketing. Think about a typical generic statin. Let’s say you’re selling it at retail at $12 for a 30-day supply, there’s not much margin there to do marketing.”

That doesn’t mean biosimilars are likely to start pouring big money into mainstream DTC advertising. Rather, most will focus on sales rep outreach, physician marketing and less pricey digital promotions directly to consumers.

Biosimilar makers are already driving education and awareness on Twitter as one social media example. Accounts including Amgen Biosimilars, Coherus BioSciences and Samsung Bioepis point to biosimilars' benefits with articles, news and research. 

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Meanwhile, biologic drugmakers continue to spend on DTC, although much less than they did when they had the market to themselves.

Amgen spent $5.7 million on Neulasta TV ads so far in 2021—two years after a raft of biosimilars were approved to compete with the bone marrow stimulant used post-chemotherapy. That’s not nearly as much as the $24.6 million it spent during the same time period in 2018, according to data from ad tracker, but Amgen is still putting dollars down.

Another departure from generics is how biosimilars are named. Small-molecule drug copycats use the generic name in the off-patent market, like sildenafil (Viagra) or tadalafil (Cialis).

Biosimilars, though, can choose brand names in addition to the FDA-imposed nonproprietary naming convention that uses the biologic reference drug name with a four-digit suffix. The result? Competing biosimilar brand names are as diverse and distinctive as the original biologic.

Johnson & Johnson’s Remicade biosimilars include Avsola, Inflectra and Renflexis. The new names create a need—or at least a distinctive enough gap—for both the original and biosimilar to sustain or build brand awareness. 

Another brand advantage for biologics lies in the status quo. If a patient is doing well with Neulasta, why switch to Udenyca, Fulphila or Ziextenzo?

Because biosimilars aren’t considered the exact same drug as the biologic, a physician may hesitate to switch a patient from a biologic they’re already taking. Phares said that's one reason biosimilar makers are expected to focus on new patient starts over switches when talking to doctors.

Biologics and their biosimilars cannot be used interchangeably. Instead, biosimilars have to get a regulatory stamp that allows it to be used in replace of a biologic for patients already doing well on their biologic prescription.

“Most physicians don’t want to get too deep in the weeds in determining which actual biosimilar the patient gets,” Greene said. “So it often falls to the office staff. If I’m a biosimilars marketer right now, I’m focusing on doctor education and patient education, but also trying to connect with office staff and make sure they understand the benefits of the biosimilar.”

Pricing will be a factor in switches, of course, but that key selling point for biosimilars is also at risk of becoming negligible once more than one biosimilar enters the market. In January, for instance, Amgen dropped the price of Neulasta below that of two of its biosimilar competitors, Udenyca and Fulphila, according to the Pharmaceutical Strategies Group’s specialty drug report.

Insurers and coverage policies are another factor to consider in biosimilar uptake that may be helped by biosimilar efficacy promotions. Payers ultimately will decide which biosimilars make the cut and which don't for reimbursement lists.

RELATED: Senate takes aim at pharma's patent schemes, pay-for-delay deals in renewed drug pricing crackdown

As one patient in the WeGo Health poll said, “I was made aware by my rheumatology consultant that the hospital was starting to switch all patients who were on biologics to a biosimilar and that the biosimilar would be just as effective.”

Another added, “I was forced to switch by my insurance company. The lower copay is appealing, but (I) want to be sure efficacy is the same.”

The shakeout for biologic and biosimilar marketing likely still lies in the future as biosimilars recover from a slow approval year in 2020 and continue working through legal challenges with biologic reference drug makers.

One big test is shaping up as Humira biosimilars prepare to enter the market, now expected in 2023. Will some biosimilars go all in on marketing—as AbbVie once did to establish Humira—to build brand with doctors and patients? Or will AbbVie's strong brand recognition, extensive patient support programs and continued marketing, albeit at a lower level, continue to keep it ahead of the pack?

Looking even further down the road, what will happen with diabetes biosimilars that are just now emerging in categories where biologic branded competition is already strong?

"The reality is that biosimilars marketing in this new world will simply have to show they are better and easier," Phares said, although just how they do that in the market will vary by brand, category and competition.

Biologic brands won’t be left out entirely either. Many can still prosper and profit in newly competitive markets if they choose.

“Innovator brands can retain market share and profit by continuing to market their drug—as long as they're willing to give up something on price to keep it going. They're still making a profit, just less,” Phares said.