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Biosimilar Drugs -A raging scientific debate with mounting global commercial interest

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On December 11, 2008, Reuters reported that two days after Merck & Co. announced a major push into generic versions of biotechnology medicines, Eli Lilly & Co. signaled similar aspirations. This report raised many eyebrows in the global pharmaceutical industry, in the midst of a raging scientific debate on this issue. Be that as it may, many felt that this announcement ushered in the beginning of a new era. An era of intense future competition with Biosimilar drugs in the world market with immense commercial interest.Globally, the scenario for generic versions of biotechnology medicines, which are called Biosimilars, Biogenerics or follow-on Biologics, started heating up when Merck announced that the company expects to have atleast 5 follow-on biologics in the late stage development by 2012. The announcement of both Merck and Eli Lilly surprised many, as the largest pharmaceutical market of the world – the U.S.A is yet to approve the regulatory pathway for generic biologic medicines. In the developed world, European Union (EU) has taken a lead towards this direction by already having a system in place for regulatory approval of Biosimilar drugs in 2003.What then prompts the research based global pharmaceutical companies like Merck and Eli Lilly to step into the arena of Biosimilar medicines? Is it gradual drying up research pipeline together with skyrocketing cost of global R&D initiatives?

The future business potential of Biosimilar medicines:

Currently, over 150 different biologic medicines are available in the Global Pharmaceutical market. However, the low cost Biosimilar drugs are available in just around 11 countries of the world, India being one of them. Supporters of Biosimilar medicines are indeed swelling as time passes by. At present, the key global players are Sandoz (Novartis), Teva, BioPartners, BioGenerix (Ratiopharm) and Bioceuticals (Stada). This market is expected to develop slowly because of regulatory hurdles in the major countries of the world.

Very recently, the EU has approved Sandoz’s (Novartis) Filgrastim (Neupogen brand of Amgen), which is prescribed for the treatment of Neutropenia. With Filgrastim, Sandoz will now have 3 Biosimilar products in its portfolio.

Raging debate on Biosimilar Drugs still continues:

The debate is centered on the argument that like small chemical molecules is it possible to replicate large biological molecule of the innovator? It is widely believed that a protein cannot be absolutely replicated. How could possibly then Biosimilar drugs be considered equivalent to the original product by a regulator and marketing approval be granted to them without full scale clinical trials ignoring safety concerns of the patients? In favor of this argument some refer to the problem of red cell aplasia that affected many patients administering Johnson & Johnson’s Exprex (Epoetin) after only a minor change made in its manufacturing procedure.

Hurdles to cross for future Market entry of Biosimilar Drugs:

Emergence of second generation branded biosimilar products such as PEGylated products Pegasys and PegIntron (peginterferon alpha) and Neulasta (pegfilgrastim), and insulin analogs etc. have the potential to reduce the market size for first generation Biosimilar drugs creating significant entry barrier.

Even otherwise, the barriers to market entry of Biosimilar drugs are much higher than any small molecule generic drug. In the markets within EU, many companies face the challenge of higher development costs for biosimilar drugs because of stringent regulatory requirements and greater lead time for product development. Navigating through such a tough regulatory environment will demand a different type of skill sets from the generic companies not only in areas of clinical trials and pharmacovigilance, but also in areas of manufacturing and marketing. Consequently, the investment needed to take Biosimilar drugs from clinical trials to launch in the developed markets, will indeed be quite significant.

Current Scenario in the U.S:

Recently in the U.S.A, the new, widely reported, biotechnology policy of President Barak Obama has become one of the most closely watched healthcare policy initiatives of the country. It is expected that such a policy will help facilitate regulatory approval process of Biosimilar drugs in the USA by end 2009. This new policy initiative could have a major impact on many biotech companies who will face new generic competition, rather quickly. On the other hand, it will prove to be a boon to the new entrants in this market like, Merck and Eli Lilly, besides the existing ones.

Global Market Potential of Biosimilar Drugs:

The biosimilar drug market in the world is estimated to be around U.S. $ 16 billion by 2011. Currently, off-patent biologic blockbusters including Erythropoietin offer an excellent commercial opportunity in this category of drugs. By 2013, about 10 branded biologics with a total turnover of around U.S. $ 15 billion will go off-patent.

Biosimilar Drugs in India:

Sales of biosimilar drugs in India are estimated to be around U.S. $ 4 billion by 2011.

Biosimilar drugs fall under high growth segment within Indian pharmaceutical Industry. Recombinant vaccines, erythropoietin, recombinant insulin, monoclonal antibody, interferon alpha, granulocyte cell stimulating factor like products are manufactured by a number of domestic biotech companies like Biocon, Panacea Biotech, Wockhardt, Emcure, Shantha Biotech, Bharat Biotech, Serum Institute of India, Dr. Reddy’s, Ranbaxy, etc. The ultimate objective of all these Indian companies, I am sure, will be to get regulatory approval of such products in the EU and then in the U.S. when the time comes.

It is worth mentioning here that to give a fillip to the Biotech Industry in India, the National Biotechnology Board was set up by the Government of India under the Ministry of Science and Technology in 1982 and the Department of Biotechnology (DBT) came into existence in 1986. The DBT now spends around US$ 200 million annually to develop biotech resources in the country and have been making reasonably good progress. The DBT is reported to have undertaken an initiative to prepare regulatory guidelines for Biosimilar Drugs, which is expected to conform to international quality and patients’ safety requirements.

The points to ponder with the Biosimilar Drugs in India:

It is, indeed, quite surprising that in India there is still no separate transparent and published guidelines for regulatory approval of Biosimilar drugs, although the Drug Controller General of India (DCGI) seems to have a different view in this matter. The Drugs and Cosmetics Acts of India have no separate provisions either, for Biosimilar Drugs. In a situation like this, we find that many Biosimilar Drugs are still getting regulatory approval in India.

Currently India supplies 30% by volume of the global requirements of generic drugs both in regulated and non-regulated markets. In the regulated markets like North America and EU, for small molecule generic products, Indian manufacturers conform to the global safety and efficacy standards by getting these products approved by the most stringent regulators of the world like, U.S. FDA, MHRA (Medicines and Healthcare products Regulatory Agency) etc. The very fact that none of the Biosimilar drugs developed in India could get approval in the EU as yet, may well suggest that the stringent regulatory requirements for both efficacy and patients’ safety followed in the EU for Biosimilar drugs, could not be met by the Indian manufacturers, as yet. The question, therefore, comes to my mind whether the Biosimilar drugs manufactured in India conform to international quality and safety standards? If not, who will address the safety concerns of the patients who are or will be administering these medicines?

Such a concern gets vindicated by widely reported serious quality problems, detected by the drug regulatory authorities, at some large and well known Biosimilar drugs manufacturing units in India and also from the condition of some vaccine manufacturing units in our country.

India needs to manufacture the world class Biosimilar drugs conforming to the highest efficacy and patients’ safety standards, just the way Indian pharmaceutical manufacturers have demonstrated with ‘made in India’ generic drugs, the world over. The Indian drug regulatory authority should now take some important initiative with the publication of world class Biosimilar drugs regulatory approval guidelines, may be following the similar process as what we see in the EU.

Currently, experts from India are participating towards preparation of ‘WHO Guidelines’ for Biosimilar Drugs. The progress made towards this direction is yet to be ascertained. Simultaneously, the DBT is reported to have under taken an independent initiative to prepare similar guidelines, the progress of which is also yet to be known.

Before other developed markets open up for Biosimilar drugs, if India can align itself with its own world class regulatory standards for the same, yet another significant export opportunity could be created for the country, competing with the best performers of the world in this category.

Meanwhile, it will only be good to know that like many other initiatives, India has taken one more important initiative to address this important issue, for the sake of humanity. As the existing process of granting regulatory approval for Biosimilar drugs continues in India, the lurking fear towards patients’ safety with such drugs will remain unabated with a large majority of experts in this field.

By Tapan Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

On ‘Patent Linkage’ – a rational argument on an emotive debate

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WTO TRIPS Article 28.1a says that the member countries agree to ensure exclusive rights to patent holder for a specific time period. In case of India, like most other countries, this time period is for 20 years.During this period the member countries agree to prevent third parties from making, using, offering for sale the patented product without the owner’s consent.In India, during last twelve months, at least 4 patents were infringed by the local generic companies. All these cases are currently under litigation. No one at this stage will possibly be able to hazard a guess as to when will these cases ultimately get resolved. If it takes another two to three years to get the final verdict from the honourable High Courts, the revenue of the innovator companies who have already launched their patented products in India will get shaved off, at least for this period, leaving a very adverse commercial impact on them. There is a theoretical possibility that it may take even more time for the honourable High Courts to resolve these cases and during the remaining period of limited patent life of these products the cases may not get resolved, at all.

Moreover, in India there is no known strong deterrent for patent infringement. In absence of which, the opportunity to make significant commercial gain through patent infringement, on the pretext of extending benefits to patients could indeed be, many a times, difficult to resist. Media reports that the National Pharmaceutical Pricing Authority (NPPA) has raised huge demand in crores of rupees for overcharging the common man, flouting the drug pricing norms, by some of these large companies involved in patent infringement litigations, vindicates the point of their basic overall intention of significant commercial gain over extending pricing benefits to the patients. The moot question that follows is who is responsible to ensure the sanctity of the product patent system in India?

The prevailing situation warrants a strong regulatory system which could prohibit marketing approval of generic equivalents of patented molecules during their patent period.

The question that is often raised in this context is who exactly be held responsible for implementation of such a system in our country? While addressing this question one should realize that it is the Government in its entirety and not just the Patent offices or any particular ministry or ministries of the Governments is bound by the WTO TRIPS Agreement. Therefore, it is justifiably the responsibility of all Government departments/ministries to ensure that TRIPS obligations of the Government on proper enforcement of patent are properly met.

The process of granting marketing approval for patented molecules, in general, rests on the Ministry of Health (MoH) of WTO member states. Thus for WTO member states to meet TRIPS obligations effective communication between the MoH and the Patent offices of the country is absolutely essential. Such a system will help prevent approval of generic versions of patented molecules before expiration of the product patents.

Establishing this communication process will ensure that one department/ministry of the Government (say DCGI) does not impair the efforts of another Government department/ministry (say IPOs) to provide effective intellectual property protection as articulated in Article 28.1 of the WTO TRIPS Agreement.

This system will ensure that Health Regulatory Authorities do not, even unintentionally, undermine the commitment of the Government to conform to the TRIPS Agreement.

My experience of the last three years of post product patent regime in India prompts the need for establishing a “Patent Linkage” system without further delay, not only for effective patent protection but also to encourage innovators to get more involved and engaged in the process of innovation in India.

Will India be the unique country if such a system of “Patent Linkage” is put in place? The answer is obviously ‘no’.

In the largest market of the global pharmaceutical industry, the USA, such a system exists. US FDA maintains a listing of pharmaceutical products known as the ‘Orange Book’. The soft copy of the ‘Orange Book’ is also available through internet at: http:/www.fda.gov/cder/ob/.

US FDA does not authorize marketing approval of generic versions of patented molecules listed in the ‘Orange Book’.

What then happens in the second largest market of the global pharmaceutical industry, the European Union (EU)? In the EU, sanctity of the product patent is ensured by granting 10/11 years data exclusivity. Thus, if any company intends to introduce a generic version of a patented molecule, it will have to generate its own sets of entire regulatory data through a very long and expensive process, which may take several years. Even after spending huge amount money and time towards generation of their own clinical data, there is no guarantee that such companies will be able to market the product without getting involved into expensive patent infringement litigation. Thus in the EU, the deterrent to make such an ambitious attempt is humongous.

Various types of ‘Patent Linkage’ system also exists in Australia, Canada, Mexico, Jordan, UAE, Singapore, China etc. While putting in place of such a system is reportedly in progress in countries like, Chile, Dominican Republic – Central America, Bahrain, Morocco, Oman etc.

To conclude, in my view, when the Government of India is the sole authority to grant product patents in India, it is the responsibility of the same Government to protect those patents through its Health Regulatory System i.e. DCGI’s office. I reckon, such a system already exists in India. The procedure of (‘Patent Linkage’) checking the patent status before granting marketing approval already exists in FORM 44, which is an application to the DCGI for grant of permission to import or manufacture a New Drug or to undertake clinical trial in India. In the first page of FORM 44 (available in the website of the DCGI) under ‘Particulars of New Drug’ in point 8, it seeks details of the ‘Patent Status of the drug’. Can this information be not effectively utilized to justifiably deny marketing approval of a generic version of a patented molecule during its patent life in India? If not, it is difficult to make out what purpose will the DCGI utilize this information for?

Thus in my view, the procedure to be followed for ‘Patent Linkage’ in India is already in place. There is hardly any need to reinvent this wheel either. The Health Regulatory Authority of India should now make this procedure work effectively in its obligation to adhere to the commitment of the national Government to honour Article 21.1 of WTO TRIPS Agreement.

By Tapan Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

National Rural Health Mission (NRHM), a much hyped public healthcare initiative – has it delivered since its inception in 2005?

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National Rural Health Mission (NRHM), a very ambitious and noble initiative for the rural population of India was launched by the Government of India on April 12, 2005. The interim budget allocation of NRHM for the year 2009–10 has been increased to Rs. 12,070 crore. The primary purpose of NRHM, as announced by the Government, was to improve access to quality healthcare for the poor population of 18 states, to start with, of rural India.

Along with such a commendable initiative, the Government declared an increase in its spending towards public health from mere 0.9% to 2–3% of the GDP over a five year period. This decision was in line with the well articulated prime focus of the Government on public health and education.

During the launch of NRHM, the Health Minister of India announced that the nation would see the results of these efforts in three years time.

Three years are over now. Let us, therefore, have a look at the key achievement areas of this ambitious scheme for the budget year 2008-09, as announced by the Finance Minister recently in his interim budget speech for 2009–10.

The performance areas were highlighted as follows:

• 462,000 Associated Social Health Activists were trained
• 177,924 villages have sanitation committees functional
• 323 district hospitals have been taken for up gradation

Against such a soft performance parameters of the Government, let us see some hard facts, which are real indicators of performance of NRHM. A report on the recent study done by Chronic Care Foundation indicates that in India about 86% of highly populated rural districts still do not have provisions for basic diagnostic tests for chronic ailments.

The study also highlights that in rural areas, as a percentage of total expenses, out of pocket healthcare costs are more than the urban areas, with hospitalization expenses contributing the most to the total costs. In many rural areas the healthcare costs have been reported to be as high as around 80% of the total expenses. Such a high out of pocket expenses have mainly been attributed to the lack of facilities in these rural areas, requiring patients to travel to distant areas for medical treatment. It was also reported that even in rural areas due to inefficient and inadequate services at the Government healthcare units, there has been a very high dependence on more expensive private healthcare facilities.

After almost four years from the inception of NRHM, if this is the state of affairs for rural public healthcare, the obvious questions which come to my mind are as follows:

• Where is the huge money allocated for NRHM going?
• Who is or are accountable for such a poor performance of this great scheme?

In my opinion, to make NRHM work satisfactorily the Government should outline, decide and announce the key success parameters for performance evaluation of the scheme. This is to be done disclosing the names and designations of the responsible senior Government officials who will be held accountable for the success or failure to deliver the deliverables. All these details should be uploaded on to the website of the Ministry of Health for public scrutiny, at least half yearly. With tax-payers money being utilised for this important and critical public health arena, no non-performance should escape attention and go unpunished.

Moreover, with the help of experts, the Government should decide, which elements of each identified success parameters the Government will be able to deliver better with its own internal resources and which are those areas where the Government should outsource.

Such an approach when worked out in great details will be able to ensure whether through NHRM the country is making progress to improve access to quality healthcare for a vast majority of its rural population. Otherwise this scheme may well be treated just as one of those which failed to deliver and vanished in the oblivion.

By Tapan Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.