How did Johnson & Johnson beat back Remicade's biosim? Call it the art of the deal

Johnson & Johnson has been surprisingly successful at fending off Pfizer's Remicade biosimilar, and that didn't happen by accident. The pharma giant's upfront dealmaking and money-off pricing did the job.

J&J used a three-pronged strategy in fighting off Pfizer's Inflectra. The first piece? The company negotiated with payers and set up exclusive contracts in nearly half the market, Bernstein analyst Ronny Gal wrote in a Thursday note to clients. "Providers were forced to stock Remicade and as provider discounts are volume dependent, there was a broad preference for the brand," he said.

Secondly, the New Jersey drugmaker bundled several drugs and medical devices together for larger hospitals, which made using Pfizer’s knockoff "less economical," Gal wrote.

And lastly, the company served up deeper discounts to large independent infusion centers, which are "more economically sensitive," according to Gal. In other words, their budgets are tighter, so competitive prices are even more important.

The result? As J&J’s execs said on Tuesday’s Q2 conference call, excluding rebate accruals in the year-ago quarter, their blockbuster sank by only about 5% for the quarter, to $1.35 billion. And that’s a decline much less severe than "us or any of you had expected," CFO Dominic Caruso told analysts, noting that "we all targeted [erosion] to be somewhere between 10% or 15%." 

Whether it can last, though—especially after other entrants arrive, such as Samsung’s already-FDA-approved Renflexis-—remains to be seen. As Caruso put it, "we feel pretty good that Remicade erosion overall, even with the entrant of a new biosimilar, will be less than we previously expected."

Gal, though, still sees opportunity for those biosim makers—though it’ll cost them. It'll also require the copycat makers to grab not only patients new to the Remicade scene, but those who've been taking the brand for awhile.

"Looking forward, it seems adoption of biosimilar Remicade will require 'complete switch' where both new and existing patients are switched to avoid a long 'tail' of products remaining on the brand," he wrote, adding that kind of change will "necessitate ... deep discounts upfront" of about 30% to 50%.

That just might happen as more Remicade copycats hit the market. Amgen is likely to enter in mid-2019, behind Samsung. "[W]e would likely see one of the biosimilars crossing the Rubicon and offering the required discounts," Gal said.

Meanwhile, for those wondering whether other drugs—specifically Amgen’s Neulasta—can replicate Remicade’s success, Gal says he wouldn’t count on it.

"Remicade is a chronic therapy while Neulasta is acute short term treatment. Significant part of the power of Remicade comes from the continuing patient rebate structure," he said.