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Drug manufacturer Pfizer to discontinue its steering pricing structure for Enbrel following discussions with ACM

Drug manufacturer Pfizer will no longer persuade hospitals in the Netherlands into purchasing anti-rheumatic drug Enbrel through its discount schemes. Pfizer has informed the Netherlands Authority for Consumers and Markets (ACM) of its plans. This will create more room for competition coming from new competitor drugs (biosimilars). This is a positive development for hospitals and patients that need these drugs. That is why ACM has decided not to conduct any further investigation into Pfizer’s discount schemes and into possible abuse of dominance.

Martijn Snoep, Chairman of the Board of ACM, explains: “We cannot stress this enough: it is important that, once a patent has expired, competition takes place on the drug market so that prices go down. If the former patent owner with a strong market position uses a pricing structure that hinders entry of biosimilars, that competition won’t get off the ground. It is therefore positive to see that Pfizer will discontinue this pricing structure for Enbrel.”

What was this case about?

In 2015, Pfizer’s patent on the active ingredient etanercept expired. That is the active ingredient of Pfizer’s anti-rheumatic drug Enbrel, which is prescribed for auto-immune diseases such as rheumatism and psoriasis. Prior to the patent’s expiration, Enbrel had been the number two drug in the Netherlands in terms of turnover, behind Humira. After the patent expired, other manufacturers, too, were able to introduce drugs based on the same active ingredient, so-called biosimilars. In the Netherlands, two biosimilars based on the active ingredient etanercept are on the market.

Information reached ACM

In the fall of 2021, ACM received information that Pfizer used a discount scheme for Enbrel that could discourage hospitals from switching to other competitor drugs. Following ACM’s investigation, it turned out that, in various contracts with hospitals, Pfizer had included a clause that enabled Pfizer to significantly reduce the discount applied to future volumes if the purchased quantities decreased by more than a pre-specified  percentage. This created the risk of a substantial financial barrier emerging for hospitals to switch drugs. After all, even after a switch, hospitals must continue to be able to purchase Enbrel for those remaining patients that cannot or do not wish to switch. For that group of patients, the price of Enbrel could become almost four times higher if the hospital switched to a biosimilar.

Following the information it had received, ACM asked Pfizer for a clarification. On the basis of its preliminary investigation, ACM informed Pfizer of its findings that the pricing structure that Pfizer used seemed to be at odds with competition rules.

Pfizer’s response to ACM’s findings

Although Pfizer does not agree with ACM’s assessment, Pfizer has indicated it will immediately remove the discount clauses from all Enbrel contracts and current bids vis-à-vis hospitals, and that it will no longer use this clause in the future either. Pfizer has informed all buyer groups that recently received a contract or bid with this discount clause of its decision. Hospitals that wish to do so can during the current contract period switch to another competitor drug, while keeping the agreed upon discount for the group of patients that cannot or do not wish to switch.

Prescription-drug prices

Fair competition in the pharmaceutical industry results in lower prescription-drug prices, and leads to increased innovation. Former patent owners with strong market positions must ensure that the discounts they give do not have any anticompetitive effects. Bids with large differences in discount rates that depend on whether or not certain conditions are met are more likely to be anticompetitive. ACM expects drug manufacturers to make reasonable, competitive bids for all patients. Should ACM receive reports that manufacturers hinder hospitals that wish to switch to biosimilars, ACM will take enforcement action.

ACM is calling on hospitals, buyer groups and competitors to continue to file reports with ACM if they are forced to continue buying from a certain manufacturer through discount schemes.